Gap Grows Between Need and Supply for Kidney Transplants

Soaring rates for obesity, diabetes and hypertension are fueling a serious gap between the need for kidney transplants and the availability of those organs, impacting Latinos and other Los Angeles patients who are in renal failure.

"There is a tremendous gap and a tremendous need" because the number of organ donors has leveled off in recent years while the number of people needing kidney transplants continues to grow, said Dr. Robert Mendez, professor of surgery at the USC Keck School of Medicine.

The kidney shortage dramatizes the urgency of having more people in Californians sign up to be organ donors to save lives via transplants, said Mendez, president of OneLegacy, a nonprofit agency that promotes organ and tissue donation in Los Angeles and six surrounding counties.

Because of the shortage, hundreds of patients will die before a kidney becomes available. For patients with kidney failure starting dialysis in the U.S., 6 of 10 will die within 5 years without a transplant, said Dr. Silas Norman, a kidney transplant specialist at the University of Michigan. Those most at risk of dying, Norman said, are people with diabetes as well as those over age 65.

Among the 3,700 Latinos now on organ waiting lists in the Los Angeles region, 3,000, or 80% of them, are in need of a kidney or both a kidney and pancreas.

But the number of donated kidneys available for transplants falls far short of that figure. In 2009, for example, 396 Latinos received kidney transplants in the Los Angeles region, according to figures from the national Organ Procurement and Transplantation Network (OPTN). This includes 265 transplants performed on Latinos from deceased donors and 115 transplants from "living donors," typically a relative or friend of the recipient. In addition, 16 Latinos got both a donated kidney and pancreas.

Meanwhile, obesity and diabetes are on the rise. Doctors in the region have diagnosed obese teenagers as young as 13 with Type 2 diabetes, which until recently almost always struck only among adults.

While the diabetes rate for all Los Angeles residents grew from 6.6 to 9.1 percent from 1997 to 2007, the rate for Latinos climbed from 9.5 to 12.8 percent, according to a Los Angeles County Public Health Department study. The study also determined that diabetes for all county residents below the federal poverty line rose from 9 to 14.7 percent.

A separate study found that high blood pressure from 1997 to 2005 grew throughout the county from 18.4 to 24.8 percent. The highest prevalence was found among people living below the poverty level. Hypertension, like diabetes, can lead to kidney failure.

The situation could be alleviated if people watched their weight and exercised more to prevent diabetes and hypertension from developing in the first place, said Mendez, a pioneering transplant surgeon.

When many Latino immigrants come to this country, "unfortunately, they change their diet and eat a lot more – large doses of carbohydrates," Mendez said. "And as people get more and more obese," they tend to develop diabetes and high blood pressure. And with those illnesses, can come kidney failure.

Norman noted that poorer people often live in urban areas that "lack access to grocery stores and healthier food, such as fresh produce." Foods that are unhealthy, meanwhile, such as fast foods and snacks, can seem appealing "because they are often less expensive."

These unhealthy trends indicate that the organ gap could get much worse.

At present, most organ donations take place when family members give consent after a loved one is brain dead, often occurring after an accident or an aneurism. New figures for this year show that Latinos are providing consent nearly 60% of the time in the region, and they are donating the largest share of organs from deceased persons of any ethnic group. Meanwhile, whites are consenting at a higher rate, 70%, while African Americans are at 57% and Asians at 39%.

But instead of having a loved one make a decision, at a time of grieving, organ donation advocates are encouraging individuals to make that choice themselves in advance, by enrolling for the state registry through the DMV or online at www.DoneVidaCalifornia.org.

The state registry, established four years ago, lists 7.5 million — or 1 in 4 licensed drivers and I.D. card holders in California. By next July, the next incremental goal is 30%, said Bryan Stewart, immediate past president of Donate Life California.

Because Latinos are the largest population segment (44%) of the Los Angeles region, they represent an important target in the registry strategy. But so far, Latinos – along with Asians and African Americans -- lag significantly behind whites.

About 15% of Latinos who got a driver's license or an ID card enrolled for the registry during a recent month, compared to 37% for whites. The rates for Asians and African Americans were slightly lower than for Latinos. Those rates emerged from an analysis by OneLegacy.

One factor for the lower percentage among Latinos is that undocumented immigrants are prohibited by law from getting a driver's license, and almost all registry enrollees have signed up through the DMV.

Stewart said certain myths about organ donation and nagging doubts also inhibit enrollment by Latinos, as well as a lack of familiarity about donation, especially among immigrants.

Donate Life maintains the registry and works closely with the DMV, which includes organ donation questions on applications for driver's licenses and ID cards.

Referring to the low enrollment figures for Latinos, Asians and African Americans, DMV Director George Valverde said: "I understand the problem is not unique to California. We'd be happy to explore any plan put forth by Donate Life and would try to do what we can to increasing the representation of nonwhite ethnic groups."

In the Los Angeles region, there were 382 donors from deceased persons in 2009. Because each donor, depending on the situation, can contribute more than one organ, they accounted for a total of 1,182 organs for transplant.

The relatively low number of donors for such a large region reflects the fact that "organ donation is a rare event," said Stewart. Only 1 death in 100 provides appropriate conditions for potential organ donation, he said. This occurs when a person is declared brain dead but his or her organs are kept functioning by medical equipment.

The conditions for tissue donation are less stringent. More than 2,000 tissue donors last year helped improve the lives of tens of thousands of people. This included skin to help burn victims heal and corneas to correct vision problems.

Elena de la Cruz, a spokesperson for OneLegacy, said that by enrolling to be donors, people can know they will continue to help others after they pass away.

Frank Sotomayor wrote this story while participating in The California Endowment Health Journalism Fellowships, a program of USC's Annenberg School for Communication & Journalism.