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Kidney PickingWhy so many of the valuable organs are going to waste.

By Jake Halpern
Posted Wednesday, Oct. 10, 2007, at 2:24 PM ET

(Continued from page 1)

Zhang's research has its limitations. To begin with, she is not a nephrologist or even a physician, and this puts her at a disadvantage when she tries to understand, on a case-by-case basis, what factors most influence doctors. Secondly, her research is not based on a controlled study, which would undoubtedly be the best option. Instead, her statistical model uses notes and other data to re-create the thinking that went on among hundreds of transplant teams, and then Zhang herself assigns numeric values to each of the many small considerations that were made. This is enough to make some kidney specialists cringe. Dr. Dicken Ko, who is the surgical director the Renal Transplantation Program at Massachusetts General Hospital, says that the medical judgments made in these circumstances can't be reduced to a set of simplified "theories, rules, or equations."

Ko maintains that a certain percentage of kidneys always end up being discarded because, inevitably, some of the organs have serious unforeseen anatomical or pathological abnormalities. "It's like apple picking," he says. "You can try to pick as many apples as you want, but not every single one will be selected for the produce store." He also dismisses the notion that doctors are so heavily influenced by a kidney's history of being rejected, because he insists that doctors are rigorously trained to rely on universal standards and to make independent judgments.

There are those, however, who are far more open to the merits of Zhang's theory. Dr. Peter Reese, who is a kidney specialist at the University of Pennsylvania Hospital in Philadelphia, is one of them. "If you knew that someone had made a bid on a house and then pulled out, wouldn't you be curious or skeptical about what had happened?" he asks. Even if the house looked fine, says Reese, it would be natural to wonder whether the inspector found termites, if there was a leak in the roof, or whether there was a problem with the deed. Reese concludes that both patients and doctors are susceptible to this type of thinking.

Ever since childhood, the idea of "leftovers" and "hand-me-downs" has been repugnant for most of us. In general, we are skeptical of things that other human beings don't want. Zhang's work indicates that this skepticism may well originate from an evolutionary mechanism that allows us to benefit from the knowledge and experience of others. It's true that doctors are trained to make independent judgments; still, even doctors are susceptible to ancient evolutionary impulses and subconscious inclinations. Many transplant specialists may bristle at the thought that they choose their kidneys and their peanut butter in a vaguely similar fashion. But the truth of the matter is that we are all, occasionally, more simple-minded than we would care to admit.

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Jake Halpern is a commentator for NPR's All Things Considered and is the author of Fame Junkies.
Photograph of an organ-transplant cooler by Custom Medical Stock Photo.
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