New
Service for TodaysSeniorsNetwork.com
readers...roll mouse over, click on
highlighted links in stories to review items
from Amazon
Now, keep up to date
with daily feeds of newly posted stories
about America's Seniors...click on the box
to the left
Extreme obesity affects chances of Kidney
transplantation
Newswise — For patients on the waiting list for a kidney
transplant, severe and morbid obesity are
associated with a lower chance of receiving
an organ, reports a study in the February
Journal of the American Society of
Nephrology.
Led by Dr. Dorry L. Segev of the Johns Hopkins University School of
Medicine, the researchers used data from the
United Network for Organ Sharing (UNOS) to
examine how obesity affects waiting times
for kidney transplantation.
"The results identify a potential bias in organ allocation that is
not consistent with the goals of our
allocation system," Dr. Segev comments.
"Obese patients are waiting longer for kidney transplants
when compared with their non-obese
counterparts, even after adjusting for all
medical factors tracked through UNOS."
Dr. Segev and colleagues analyzed data on more than 132,000
patients wait-listed for kidney transplants
from 1995 to 2004.
As obesity increased, the
likelihood of receiving a transplant
decreased.
Adjusted for other factors, the chances of receiving a kidney
transplant were 27 percent lower for
patients classified as severely obese and 44
percent lower for morbidly obese patients,
compared to normal-weight patients.
(The chances of receiving a transplant were not significantly
reduced for patients classified as
overweight or mildly obese.)
In addition, when a kidney became available, patients in the
highest categories of obesity were more
likely to be "bypassed"—that is, their
physician was more likely to decline the
offer of a kidney.
The chances of being bypassed were 11 percent higher for severely
obese patients and 22 percent higher for
morbidly obese patients.
The findings raise concerns that obesity may be a previously
unappreciated source of bias in organ
allocation.
"It is possible that providers are bypassing obese patients and
instead transplanting non-obese patients
because they feel that kidneys are a scarce
resource and they want the kidneys to go to
the patients who will benefit most from
them," says Dr. Segev.
"However, there is strong evidence that even obese patients will
benefit significantly from a kidney
transplant. And more importantly, the U.S.
organ allocation system is not based on such
medical decisions, but instead is based on
the notion that everyone who gets listed
deserves a fair chance at getting
transplanted."
The bias might play out in other ways as well. Obese patients tend
to have worse outcomes, which may reflect
badly on the results achieved by doctors or
hospitals—possibly even affecting quality
measurements, which are increasingly tied to
reimbursement.
In addition, the reimbursement for transplant surgery is the same
for difficult or complicated cases as for
simpler cases.
"These two practices generate a strong disincentive against
challenging cases, and could potentially
contribute to the bias against obese
patients that we saw in our study," says Dr.
Segev.
Dr. Segev notes that matching an available organ with an
appropriate recipient requires clinical
judgment, which could not be fully captured
in this study.
"However," he adds, "it is unlikely that these factors could
explain such dramatic observations."
The study is available online at
http://jasn.asnjournals.org/
and in print in the February issue of the
Journal of the American Society of
Nephrology (JASN).
As a study of the United Network for Organ Sharing database, this
work was supported in part by Department of
Health and Human Services Health Resources
and Services Administration contract
234-2005-370011C.
The ASN is a not-for-profit organization of 10,500 physicians and
scientists dedicated to the study of
nephrology and committed to providing a
forum for the promulgation of information
regarding the latest research and clinical
findings on kidney diseases