The Pediatric Transplant Advantage: A Looming Crisis for Young Adults on Dialysis
A growing concern is emerging within the organ transplant community: a potential disadvantage for young adults on dialysis (YA+OD) compared to their pediatric counterparts. Dr. Justin Steggerda, a leading researcher in this field, sheds light on this disparity in his groundbreaking study, revealing a stark contrast in transplant outcomes.
“Our study revealed that YA+OD patients are less likely to receive a deceased donor kidney transplant compared to both pediatric patients already on dialysis and those who are not yet on dialysis,” explains Dr. Steggerda. “They also face longer wait times, a higher risk of being removed from the waitlist, and an increased likelihood of experiencing graft failure – underscoring the precarious nature of their situation. This disparity seems deeply concerning.
This finding raises critical questions about the fairness of the current organ allocation system and the urgent need for a closer look at how we prioritize transplant candidates. The study highlights that YA+OD patients, often overlooked in medical discussions, face unique challenges that necessitate a more equitable approach.
Dr. Steggerda argues for a serious reconsideration of the existing pediatric advantage policy,advocating for adjustments that prioritize the critical needs of YA+OD patients. “We advocate for a revision of current policies to ensure that YA+OD patients are not disadvantaged simply because of the timing of their transplant listing,” he asserts. “This coudl involve exploring alternative allocation criteria that consider factors specific to this population, such as time on dialysis, medical urgency, and individual patient needs.”
This message carries significant weight for healthcare professionals, policymakers, and the general public. It calls for a deeper understanding of the challenges faced by YA+OD patients and a commitment to building a more equitable and compassionate organ transplant system.
“What message do you hope this study sends to healthcare professionals,policymakers,and the general public?”
“We hope this study serves as a wake-up call,” Dr. Steggerda emphasizes. “It’s time to recognize the unique needs of YA+OD patients and prioritize their access to life-saving transplants.A fairer system is not only morally imperative but also essential for ensuring that all patients have an equal chance to thrive.”
A Silent Crisis: Young Adults on Dialysis Face Disparity in Transplant Allocation
Imagine facing a life-altering condition requiring dialysis, yet finding yourself at a disadvantage in the fight for a life-saving transplant simply because of your age. That’s the reality for many young adults on dialysis (YA+OD) who start dialysis as children but aren’t listed for a kidney transplant until adulthood.
A recent study sheds light on this silent crisis, revealing a stark disparity in outcomes for YA+OD patients compared to their pediatric counterparts. The study, analyzing data from the OPTN Standard Transplant and Research (STAR) file, focused on patients aged 11-25 who were waitlisted for kidney transplants between 2001 and 2022.
“Current allocation policies benefit patients who are listed before turning 18, without recourse for individuals who are on dialysis as pediatric patients but are not listed until after becoming an adult,” explains Dr. Justin Steggerda, an abdominal transplant and hepatobiliary surgeon at Cedars-Sinai and lead author of the study.
This disadvantage stems from a well-intentioned policy known as “the pediatric advantage,” implemented in 2014 to prioritize pediatric candidates waitlisted before 18 years old when allocating deceased donor kidneys. While this system has undoubtedly saved lives, it inadvertently leaves YA+OD patients at a significant disadvantage.
The study’s findings are deeply concerning. Young adults on dialysis were found to be:
- Less likely to receive a deceased donor kidney transplant (DDKT): Only 59% received a DDKT compared to 84.9% of pediatric patients on dialysis (OD) and 64.7% of pediatric patients not yet on dialysis (NYOD).
- More likely to be removed from the waitlist.
- More likely to experience longer wait times, with a median time from dialysis initiation to transplant of 1008 days—far exceeding all other groups in the study.
- More likely to experience graft failure.
These disparities highlight the urgency for change. Dr. Steggerda and his team advocate for a revision of current policies to ensure YA+OD patients are not unfairly disadvantaged.
“we need to explore alternative allocation criteria that consider factors specific to this population, such as time on dialysis, medical urgency, and individual patient needs,” Dr. Steggerda emphasizes.
Addressing this issue is about more than just numbers; it’s about ensuring fairness and equal access to life-saving transplants for all individuals on the waitlist, regardless of when they begin their journey with dialysis.
.org/10.1111/petr.70023
Given the study’s findings on the disadvantage faced by YA+OD patients, what specific recommendations would you make too policymakers regarding adjustments to the current pediatric advantage policy?
Addressing the Pediatric Transplant Advantage: A Conversation with Dr. Justin Steggerda
A new study shines a light on a concerning disparity within kidney transplant allocation policies. While policies aimed at prioritizing pediatric patients have undoubtedly saved lives, they may inadvertently disadvantage young adults who begin dialysis as children but are not listed for a transplant until after turning 18. Archyde sat down with Dr. Justin Steggerda, abdominal transplant and hepatobiliary surgeon at cedars-Sinai and lead author of the study, to discuss thes findings and their implications.
Dr. Steggerda, your study highlights a significant discrepancy in transplant outcomes for young adults on dialysis (YA+OD) compared to their pediatric counterparts.Can you elaborate on this disparity?
Certainly. the policy known as the “pediatric advantage,” implemented in 2014, prioritizes pediatric candidates waitlisted before 18 years old when allocating deceased donor kidneys. While this was designed to improve access to organs for younger patients, it unfortunately creates a significant disadvantage for YA+OD patients.these individuals begin dialysis as children but are not listed for a transplant until adulthood.
- Stay informed about developments in transplant policy by visiting the websites of organizations like the OPTN and the American Transplant Foundation.
- Engage with your elected officials and urge them to support policies that prioritize equitable access to transplantation.
- Consider sharing this story with your friends and family to raise awareness and encourage dialog.
