ACOT Living Kidney Donor Organ Allocation

Kidney Paired Donation Workgroup Recommendation (Updated)

UPDATED March 8: See below the graphic.


Here’s the final recommendation from the Kidney Paired Donation Work Group recommendation as presented at the ACOT meeting today:

KPD recommendation





Update March 8, 2013: I posted this graphic yesterday during the ACOT meeting while I was live-tweeting. I wanted my twitter followers to access the information as soon as possible. However, I think it’s important to understand why this recommendation is important and how it affects all living donors.

Kidney Paired Donation (KPD) encompasses everything from a simple swap to a multiple transplant chain. Generally, the exchanges originate in one of two ways: 1. a prospective living kidney donor is found to be incompatible to an intended recipient, or 2. a person decides they want to donate a kidney but they have no intended recipient. Right now, the transactions take place within one center or across multiple centers. Standards, practice, policies and otherwise are determined by the participating hospitals, which is to say that we have a wild-west-anything-goes sort of thing happening, which leaves giant holes where protections and respect for living donors should be.

One of the transplant industry’s go-to statements is that transplants ‘save money’. Their reasoning is that the cost of a transplant is cheaper than a lifetime on dialysis. Oh, and because Medicare covers dialysis, transplants are saving ‘the taxpayers’ a truckload of money. Except:

A. not all transplant recipients are on dialysis at the time of transplant.

B. transplants are not cures, so the vast majority of recipients will need multiple transplants to achieve a ‘normal’ lifespan.

C. transplant recipients must take anti-rejections meds indefinitely, and those things are expensive (a quick web search cites numbers like $17,000-$19,000 per year or $1750 per month, or $10,000 in the first year).

D. Medicare Part D doesn’t allow the government to seek reduced rates for medications, so they’re paying full freight.

(I want to add an E here that says Medicare will only pay for immunosuppressants for three years if a recipient is not otherwise qualified to be on Medicare/Medicaid. While I can’t find a specific number, it’s well documented that a certain percentage of grafts are lost every year due a recipient’s inability to afford their antirejection drugs. That being said, the average age of end-stage renal disease diagnosis is 64.4 years old, per USRDS)


Finally, according to the Milliman Report, it costs approximately $1 million to get a person with end-stage renal disease to transplant. 


I’ve spelled all of this out not only because the transplant industry continues to insist that transplants are less expensive than dialysis, so utilizing willing but incompatible prospective living kidney donors is an all-over win situation, but because a portion of the Kidney Paired Donation Workgroup’s presentation and recommendation involves money.

Because now kidney paired donation is suddenly more expensive.


But for that, and the rest of the explanation,you’ll have to see Part II