Analysis of the Renal Transplant Waiting List at the National Taiwan University Hospital: Eleven-Year Case Review

The first living-related and cadaveric kidney transplantation at the National Taiwan University Hospital ( NTUH) were done in 19681 and 1969, respectively. These were the first kidney transplantations in the Asia as well. However, the kidney transplantation program was not well organized at the NTUH before 1988. The laws of organ transplantation and brain death were legislated in Jun. 1987 in Taiwan, and Taiwan became the first Asian country to have a law to allow brain-dead patients to donate organs. From then on, every patients must be registered on the waiting list before he/ she underwent cadaveric renal transplantation at the NTUH. The purpose of this study was to analyze the renal transplantation waiting list at the NTUH from 1988 to 1998. PATIENTS AND METHODS After a patient was registered on our renal transplantation waiting list, the patient must be followed up at our pretransplant clinics every 3 to 6 months to maintain his active waiting status. If the patient did not come back, the transplantation coordination nurse will call the patient to decide his/her status on the waiting list. We collected the data of the waiting patients ’ ages, sexes, ABO blood types, dialysis status at the registry, outcomes on the waiting list, and waiting time before the kidney transplantation. RESULTS From Jan. 1988 to Dec. 1998, 951 patients were registered on the renal transplantation waiting list of the National Taiwan University Hospital. The sex was male in 516 (54.4%) patients, and female in 435 patients. Dialysis at the registry was hemodialysis in 895 (90.3%) patients, and continuous ambulatory peritoneal dialysis in 92 patients. The ABO blood types distributions were O (n=431, 45.3%), A ( n=241, 25.3%) , B (n=220, 23.1%), and AB (n=59, 6%). Their ages at the registry were 37. 2±11.6 years old, and their ages distributions were 0~10 year (n=10, 1.1% ), 11~20 (n=44, 4.6%), 21~30 (n=245, 25.8%), 31~40 (n=295, 31.0%), 41~50 ( n =214, 22.5%), 51~60 (n=118, 12.4%), 61~70 (n=23, 2.4%), and 71~80 (n=2, 0.2%). Most patients’ ages at the registry were between 20 and 50 years old. When the data were analyzed in Jan. 1999, 274 registered patients had underwent renal transplantation, 17 patients had died on the waiting list , and 660 patients were still on the waiting list. Of 274 renal transplantation recipients, 172 patients received cadaveric donor kidneys, 44 patients received living-related donor kidneys; and 58 patients went abroad to get donor kidneys. Table 1 reveals the average yearly number of renal transplantation in each group, and the waiting time of the recipients who received cadaveric donor kidneys at our hospital. The number of cadaveric renal transplantation increased. However, the number of living-related renal transplantation decreased, and more and more waiting patients went abroad to find donor kidneys. Because of increased cadaveric organ donation, the waiting time for a cadaveric donor kidney decreased in the recent 2 years. However, it was still a long waiting time averaging one and a half years. For those patients who finally went abroad to undergo renal transplantation, the time intervals between the registries on our renal transplantation waiting list and their overseas renal transplantations were distributed in a binodal curve. The time intervals were 0~180 day in 26 patients, 181~360 days in 10 patients, 361~ 540 days in 4 patients, and more than 540 days in 18 patients. DISCUSSION Scarcity of donor organs was the bottleneck to the organ transplantation, especially in the oriental countries where cadaveric organ donation was not common. 2 The total number of renal transplantation at our hospital was increasing due to increased cadaveric kidney donation. However, the number of living-related renal transplantation decreased much when the number of cadaveric kidney transplantation was increasing. Because of the increasing cadaveric kidney transplantation, every patient on the waiting list expected to get a cadaveric donor kidney, and the family were reluctant to undergo operations to donate kidneys. Therefore , the number of living-related renal transplantation decreased year by year. Although the number of cadaveric renal transplantation was increasing, the number of patients on the renal transplantation waiting list was increasing as well. Now, the waiting time before cadaveric renal transplantation was still long at our hospital, and averaged one and a half years. As the economics in Taiwan improved, more people afforded to go abroad to find a donor kidney. Some people did not want to wait a long time for a cadaveric donor kidney, or they had waited for a long time, but never got a cadaveric donor kidney; these people would go abroad to find a donor kidney. The situation was well explained by the waiting time of the overseas renal transplantation patients. The distribution curve of their waiting times was binodal; one peak was less than 180 days, and the other was more than 540 days. Since we do not encourage organ trading, we should encourage cadaveric kidney donation and living- related kidney donation in order to increase kidney transplantation number in Taiwan in the future .