Though recent advances in science and technology have made kidney transplants available to more people than ever before, there still is a large gap between the number of people who need transplants and those who receive them.
Peter Kennealey, MD, FACS, professor of transplant surgery in the University of Colorado Department of Surgery, notes that in 2024, just under 28,000 kidney transplants were performed in the U.S. — 6,400 of which were from living donors — compared with the nearly 98,000 people who are currently on the waiting list.
“We still have a sizable gap in terms of the number of waitlisted people and the number of total transplants done annually,” Kennealey says. “Not everyone who has renal disease is a candidate for renal transplant, due to comorbidities or other factors, but we are trying to expand ways to help make more people candidates.”
Kennealey points to five innovations that are aimed at raising the number of people who get off the waiting list and into the operating room.
Nondirected donors
The majority of living donors who donate a kidney to someone in need are either friends or relatives of the recipient. But some donors are “nondirected,” meaning that they donate a kidney because they want to give someone they don’t know a chance at a better life. (The same thing is possible with liver transplants, since surgeons can use a small part of a donor liver to grow a new liver in a recipient.)
“We see a high number of nondirected donors for kidney transplant and also for liver transplant at the University of Colorado,” Kennealey says. “I don't know why that is specifically — if there's a population bias or something like that — but we do see that quite a bit. We see probably a few a month.”
Robotic transplant surgery for high-BMI patients
Until recently, patients with a body mass index (BMI) of 25 or higher weren’t eligible for kidney transplant, given the difficulty of physically performing an open surgery on a thicker abdomen. CU Department of Surgery faculty member Thomas Pshak, MD, is on the front lines of a new program to perform robotic surgery on high-BMI patients. Because the robot allows the surgery to essentially be performed inside the body, using very small incisions, BMI is no longer a factor in who does or does not receive a kidney transplant.
“By operating on the inside, I can see so much better,” Pshak says. “I can do the operations so much better because I'm literally right there, versus when I'm standing outside of a patient. As the abdomen gets bigger and deeper, it's harder and harder because my hand has to go farther and farther in, and I can’t see very well. With the robot, all that goes away. It doesn’t matter your size or shape."
Paired kidney exchange
Your brother isn’t a match to donate a kidney to you, but he is a match for someone in Chicago whose sister happens to be a match for you.
That’s dumbing it down a bit, but it’s essentially the idea behind paired kidney exchange, a program in which you have a donor willing to donate a kidney on your behalf, but you are incompatible with the donor or want to try to find a better match. With a paired exchange, your donor will donate their kidney to another recipient in exchange for a compatible kidney for you.
“We’re very engaged in paired kidney exchange at CU,” Kennealey says. “By getting involved in that program, you’re not obligated to sit on the deceased donor list and wait three or four years for a match. The paired kidney exchange through the National Kidney Registry facilitates upward of 20% of all living donor kidney transplants in the nation. They're the busiest, most sophisticated paired kidney exchange program in the world, and we've worked with them for a long time.”
Xenotransplantation
In May 2024, surgeons at Massachusetts General Hospital performed the first successful surgery to transplant a genetically modified pig kidney into a human. It’s an experimental procedure that has yet to be tested in clinical trials, but it shows promise for expanding the number of available organs, especially for ethnic and racial minorities, who typically have a smaller donor pool.
“It will take a massive amount of infrastructure and a massive team of people to do this right,” Kennealey says. “It's not going to be tomorrow or next year, but in my professional lifetime, I think xenotransplantation will become more common.”
Social media
Very few people who need a kidney transplant go around with a T-shirt or bumper sticker advertising the fact that they have advanced kidney disease. But given the fact that having a living donor tends to get you a kidney a lot faster than getting on the waiting list for a deceased donor, the more people who know you need a kidney, the better.
“Many people keep their health-related data private, which is very normal, but in kidney transplant, that is actually a disadvantage, because the more people that know about your kidney disease, the higher the likelihood is that one or more of those people would step forward,” Kennealey says. “Social media is exceedingly powerful at getting the word out.”
