Hard choices and kidney donation

Since 1986, human kidneys have been distributed based mostly on who's been waiting longest. That's fair, but not efficient in extending the lives of as many people as possible for as long as possible.

So a proposal to give preference to the youngest, healthiest patients who need kidneys over older, sicker people who have been on the list longer, makes sense. So would a move, also part of the changes, to more closely match donors and patients in age, because, for instance, a kidney harvested from an 18-year-old could last 70 years, at least 50 years longer than a 75-year-old recipient could use it.

About 87,000 Americans need kidneys. Each year about 17,000 get one, while 4,600 die waiting.

The new guidelines would apply only to kidneys from dead donors, not live ones, who often give to help a specific person.

The specifics of the changes are still being written, and the public has until April 1 to comment via the United Network for Organ Sharing, the nonprofit organization that administers organ donation for the federal government.

Giving preference to younger, healthier patients will help society get more out of kidneys, but for real progress to be made, a bigger problem must be conquered. Less than 40 percent of us are registered organ donors and it's that fact, not the method of allocating the organs, that's costing lives.