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Status as of June 2020

You might notice that things look at little different around here. In an effort to reduce costs, I switched webhosts, which meant completely deconstructing Living Donor 101 (built back in the dark pages of css by yours truly) and consolidating it and Living Donors Are People Too into one site.

There are, undoubtedly, broken links and other issues; I will attempt to fix them when I can.

Living Donor related shirts and stickers are available at the following links:

https://www.zazzle.com/store/conspicuouschick

https://www.zazzle.com/store/livingdonor101

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It’s Time

I officially turned off the auto-renewal on this domain name. So, sometime in December of 2017, this blog will disappear. For the sake of all current and future living donors, I sincerely hope someone will build upon what I’ve begun and maintained. Take care of yourselves.

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Incompatible Kidneys Are Twice As Expensive, Half as Good

Desensitization protocols and the unimportance of tissue matching are all the rage in the transplant world these days. They’re heralded as a solution to the so-called organ shortage (no matter that the ‘active’ kidney transplant list has been flat, if not declining, for many years now), and a plethora of propaganda-type media articles have followed. In fact, according to these authors, the propaganda has filtered into academic articles as well.

To be blunt:

This analysis by Axelrod et al concludes that transplanting across the ABO blood barrier “appears clinically and economically appropriate.” We think this conclusion is not justified by the analysis.

 

Specifically:

“The authors estimated Medicare spending for all covered services for 270 ABO-incompatible (ABOi) and 27 000 ABO-compatible (ABOc) transplants for the period 30 days before transplant through 3 years after transplant and found that costs for ABOi transplants were 74% higher than those for ABOc transplants.

“The authors also estimated adjusted hazard ratios (AHRs) for both graft failure and all-cause mortality…showed that ABOi-transplanted patients had 1.9 times the risk of both death and graft failure compared with ABOc patients.”

 

in short:

“These estimates indicate that ABOi transplantation costs more and has a large negative impact on the health of recipients compared, with ABOc transplantation.”

Whoops.

 

Here’s an important point:

“The authors provide some evidence of a trend toward ABOi transplants being performed more frequently in patients with private insurance than in patients with Medicare insurance. This would be consistent with transplant centers being able to pass on the higher cost of ABOi transplants to private insurance companies but not to Medicare, which generally has a fixed price per transplant procedure”

 

Not coincidentally, the more transplants performed, the larger a surgeon’s and hospital’s revenue stream. It shouldn’t be surprising they’d promote ABO-incompatible transplants over dialysis to those with private insurance. After all, surgeons and hospitals don’t profit from dialysis. Besides, the federal government (Dept of Health and Human Services via CMS) only measure a hospital’s one-year graft and patient survival rate. What happens after that isn’t the surgeon’s or the hospital’s responsibility. So why not take the money and run?

 

 
Held, P., & McCormick, F. (2016). ABO-Incompatible Kidney Transplants: Twice as Expensive, Half as Good American Journal of Transplantation, 16 (5), 1343-1344 DOI: 10.1111/ajt.13638

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Kidney Donors’ Cholesterol Linked To Kidney Disease

The authors examined 292 living kidney donors a median 14 months post-donation and found that renal function (GFR) was associated with Total Cholesterol and Low-Density Lipoprotein levels.

 

“The likelihood of CKD [chronic kidney disease, as defined by a glomerular filtration rate < 60 mL/min/1.73 m2] at last follow-up was greater in [living kidney] donors with elevated [total cholesterol] and [Low Density Lipoprotein] levels”

 

By the way, Dyslipidema can be caused by chronic kidney disease, and is prevalent in kidney transplant recipients.

 

Yoon, Y., Choi, K., Kim, K., Yang, S., & Han, W. (2015). Clinical Assessment of Lipid Profiles in Live Kidney Donors Transplantation Proceedings, 47 (3), 584-587 DOI: 10.1016/j.transproceed.2014.12.035

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Transplant Wait List Watch 2015

As of today, there are 78,004 active people on the OPTN wait list.

A decrease of 2.34% from December 26, 2014.

 

123,259 total candidates (inactive and active). On December 26, 2014, there were 109,762.

A 12.3% increase.

That’s 45,255 INACTIVE people on the wait list.

Reminder: inactives couldn’t undergo a transplant even if a kidney became available.

 

 

Prior checks:

December 26, 2014: 79,870

September 21, 2014: 79,127. 

March 18, 2013: 74, 758.

January 20, 2013: 74,352.

November 9, 2012: 74,558

August 11, 2012: 73,104

June 24, 2012: 73,146

May 11, 2012: 73,141

January 30, 2012: 72,428

December 29, 2011: 72,656

November 28, 2011: 72,625

October 18, 2011: 72,642

August 23, 2011: 72,318

Aug 4, 2011: 72,400

July 20, 2011: 72,345

July 10, 2011: 72,360

July 5, 2011: 72,319

May 23, 2011: 72,298

May 11, 2011: 72,244

April 29, 2011: 72,330