Categories
OPTN Transplant Wait List

Transplant Wait List Watch 2016 #3

OPTN 8-11-2016As of 10:31 am on August 11, 2016, OPTN says there are 77,358 folks on the active US transplant wait list.

That’s a .33% decrease since May 10, 2016, and a 6.95% increase since this project began on April 19, 2011.

 

<- By using the larger statistic, OPTN, the government and the media are inflating the true wait list by 35.53%! 

 

Today, there are 107,290 kidney wait list registrations (active & inactive) and 99,387 candidates for a total of 7903 multiple listings (folks registered at more than one transplant center).*

 

May 10, 2016: 108,046 registrants and 100,102 candidates for 7944 multiple listings.

September 21, 2014108,989 kidney wait list registrations and 101,244 candidates, for 7745 multiple listings.

 

Kidney wait list registrants have decreased 1.55% since September 21, 2014. .

Kidney wait list candidates have decreased 1.83% since  September 21, 2014.

 

14.424 kidney wait list registrants have undergone at least one prior transplant. 13.44% of registrants.

13,109 kidney wait list candidates have undergone at least one prior transplant. 13.19% of candidates.

 

May 10, 2016: 14,601 kidney wait list registrants have undergone at least one prior transplant (compared with 16,054 on 9-21-2014. 14.7%) – 13.5%

13,252 kidney wait list candidates have undergone at least one prior transplant (compared with 14,493 on 9-21-2014. 14.3%) – 13.2%

 

Prior check-ins:

May 10, 2016: 77,617
March 18, 2016: 78,104
October 19, 2015: 79,052
August 23, 2011: 72,318
July 19, 2015: 78,296
May 19, 2015: 79,134.
April 9, 2015: 78,196
March 10, 2015: 78,012.
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
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

 

*Click on Data -> View Data Reports on OPTN’s menu. Then “National Data”. Category “wait list”. “overall by organ” Compare “Registrations” with “Candidates” to determine multiple listings.

 

**Back on that “National Data” screen. Choose “Organ by Previous Transplant”.

Categories
Deceased Organ Donation Organ Allocation

Older Kidneys Are A Good Alternative For Older Recipients

“[Deceased donor] organs from older donors are often discarded due to the macroscopic appearance of the parenchyma or major vessels. On the other hand, a large number of elderly patients are potential candidates for kidney transplantation, while many kidneys from elderly deceased donors are discarded due to a lack of age-matched recipients. In addition, a large number are often discarded due to the lack of compatible recipients among elderly patients undergoing chronic dialysis.”

“From 2007 to 2012, we performed a prospective observational study comparing 26 elderly patients receiving PKT with a control group of 26 elderly patients receiving a first transplant after prior dialysis.”

 

“Mean age of recipients was 74.3 ± 2.9 years and mean age of donors was 73.8 ± 4.1 years.”

 

“Death-censored graft survival was 96% in the PKT pre-emptive kidney group; prior to dialysis] group and 68% in the control group, at 5 years after transplantation. Immediate and delayed graft function occurred in 92% and 3.8%, respectively, of patients in the PKT group and 53% and 34.6% of patients in the control group . Acute rejection was significantly more frequent in PKT patients (23.1% vs 3.8%).

At the end of follow-up time 35.5 ± 20.1 months, the glomerular filtration rate GFR] was similar in both groups (42.2 ± 11.7 vs 41.7 ± 11.2 ml/min, p-value = 0.72). Patient survival was similar in the two groups.”

 

Morales, E., Gutiérrez, E., Hernández, A., Rojas-Rivera, J., Gonzalez, E., Hernández, E., Polanco, N., Praga, M., & Andrés, A. (2015). Preemptive kidney transplantation in elderly recipients with kidneys discarded of very old donors: A good alternative Nefrología (English Edition), 35 (3), 246-255 DOI: 10.1016/j.nefroe.2015.07.003

Categories
Deceased Organ Donation OPTN Transplant Wait List

Transplant Wait List Watch 2015, #5

Today, October 19, 2015, there are 79,052 *active* folks on the OPTN transplant wait list.

That’s a .965% increase since July 19, 2015, and 9.29% increase since April 29, 2011.

 

Note: OPTN lists a total of 122,516 candidates, which translates into 43,464 inactive candidates, or 35.47%. Since OPTN changed policy in 2003, allowing “inactives” to remain on the list indefinitely, the wait list has consistently been bloated by 1/3.

In addition, more than half of wait list deaths are inactive candidates.

 

Prior check-ins:

July 19, 2015: 78,296

May 19, 2015: 79,134.

April 9, 2015: 78,196

March 10, 2015: 78,012.

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

Categories
Living Donor Risks Living Kidney Donor

More on Kidney Donor Jamie Donaldson’s Death

On April 16, 2015, Jamie Donaldson died while donating a kidney to his father, Frank Donaldson, at Gulf Coast Medical Center in Fort Myers, Florida. Per federal guidelines, Gulf Coast’s transplant services were suspended until an investigation is complete.

Liz Freeman, of the Naples Daily News, has been covering this story from the beginning. Below is her latest contribution. The original article can be found here. It, unfortunately, requires one to be a subscriber to see the whole thing. Transcription below.

 

Man who donated kidney to dad died from internal bleeding, autopsy shows

 

John “Jamie” Donaldson bled to death after donating a kidney to his ailing father at Gulf Coast Medical Center this past spring, according to an autopsy report released Wednesday.

The excessive bleeding was due to failure of a clamp or staple that should have sealed the renal artery stump after the left kidney was removed for the transplant, according to the Lee County Medical Examiner’s Office.

In addition, there was a small cut to the aorta just below the left renal artery but it had been closed by a metallic staple, the report said. The medical examiner said the death was accidental.

The autopsy for the 40-year-old Cape Coral resident sheds light on what went wrong during the April 16 living kidney transplant surgery at Gulf Coast. Donaldson’s death led the hospital to voluntarily halt all kidney transplants involving living donors while a probe was conducted.

Donaldson was donating a kidney to his 69-year-old father, Frank Donaldson, also of Cape Coral, who learned of his son’s death after waking up in the recovery room.

The suspension of transplants for living kidney donations took effect April 21 and is still in place. Other patients and their living donors are in waiting mode or transferring to other transplant programs.

The United Network for Organ Sharing, which operates the nation’s transplant program under contract with the federal government, was notified. The U.S. Department of Health and Human Services, which contracts with UNOS, also has been informed.

Lee Memorial Health System, which runs Gulf Coast, issued a statement Wednesday:

“The autopsy supports our initial assessment that the patient experienced excessive bleeding, which is a rare, but known complication,” hospital spokeswoman Mary Briggs said. “All potential kidney donors go through an extensive medical clearance process, which includes a comprehensive medical and psychosocial evaluation to determine if they are suitable for organ donation. After undergoing this extensive evaluation, Mr. Donaldson was cleared for the kidney donation.

“Our deepest sympathies are with the Donaldson family during this difficult time and to our extraordinary caregivers who are dedicated to healing patients even in the most trying circumstances.”

Frank Donaldson said Wednesday he had not seen the autopsy report.

“I haven’t dealt with Jamie’s situation yet,” he said, using his son’s nickname. “I want to heal myself. Eventually I will. Until then, I have to get myself in decent shape.”

His son’s death after he received a new life without dialysis is not a good feeling, he said.

“No father should bury their child before him,” he said. “No matter what I do, it isn’t going to bring Jamie back.”

The transplant went well and Frank Donaldson goes weekly to his kidney specialists for progress checks, from blood work to adjustments for anti-rejection medications, he said.

The hospital reached out to him early after the transplant but not recently, and he has not spoken with the transplant surgeon. He isn’t surprised by that.

“I’m a tough old dude. I’ve been around a long time. I am pretty patient waiting for someone to talk to us,” he said. “Sometimes a one-on-one can save a lot of grief and costs in court.”

There’s another issue, he said, and that’s the $1 million life insurance policy he paid for in his son’s name in case something went wrong. His son’s wife, Christine Donaldson, is the beneficiary.

The life insurance company sent her a letter refusing to pay the claim, Donaldson said. She is having to deal with that issue now, along with how her three children are coping with the loss of their father, he said.

Categories
Advocacy Living Donor Protections Living Donor Research Living Kidney Donor

How to Eliminate Some Living Donation Related Costs

Note: Typical with most recently published studies, I’m only able to see the abstract for this one.

 

Authors collected info from 194 living kidney donors enrolled in the KDOC study.

“Most LKDs (n=187, 96%) reported one or more direct costs, including ground transportation (80%), healthcare (24%), lodging (17%) and air transportation (14%)…..Higher total costs were significantly associated with longer distance traveled to the transplant center”

 

As I’ve discussed at length, not only is it not medically necessary for a potential living kidney donor to have their procedure at the same transplant center as their recipient, it can also be detrimental for the kidney donor’s care, recovery and treatment. Transplant centers prefer both parties to be at the same hospital because –

A. It’s convenient for them.

B. Variations in how transplant centers evaluate potential living donors results in a quality control issue. Transplant center 1 might miss something that transplant center 2 deems exclusionary, etc

C. Transplant centers are paid by the procedure, so having folks at different hospitals splits the revenue pie.

D. If the kidney donor and transplant recipient live in different states, there can be insurance and billing conflicts and issues.

 

How to fix the problem (for the living donor, at least):

1. Put *all* treatment for ESRD and kidney failure under Medicare (this would delight private insurance companies btw), or at minimum, have Medicare assume all healthcare expenses if the prospective living donor and would-be recipient reside in different states to circumvent the state insurance regulation obstacles.

2. Completely standardize the living donor evaluation and selection process.

3. Require insurance companies or transplant centers to pay for the living donor’s travel and lodging expenses. (This, however, would still leave the LKD at risk. S/he must return home at some point and could need further treatment)

 

“Few LKDs reported receiving financial support from the transplant candidate (6%), transplant candidate’s family (3%), a nonprofit organization (3%), the National Living Donor Assistance Center (7%), or transplant center (3%).”

Donation is an act of generosity, which causes the prospective LKD to bear the burden (in this case financial) by themselves. Transplant candidates (aka would-be recipients) are taught, in a million subtle ways, to passively accept the sacrifice a donor is making on their behalf. Maybe we need to change the dialogue from one of recipient entitlement to one of recipient responsibility? Rather than expecting the government (NLDAC) or a nonprofit to help with living donation related expenses, transplant candidates should be prepared to assume these costs. If a would-be recipient is unable or unwilling to do, s/he could continue on dialysis and wait until a deceased donor organ becomes available.

If this idea offends your sense of fairness (Poor people won’t get living donor kidneys!), I hear you, but it’s also the reality of how our healthcare system works in general. If someone can’t afford a treatment or medication, that person can’t have that treatment or medication. Is that unfair? Certainly. But then again, one could argue, so is asking another person to act as your medical supply.

 
Rodrigue, J., Schold, J., Morrissey, P., Whiting, J., Vella, J., Kayler, L., Katz, D., Jones, J., Kaplan, B., Fleishman, A., Pavlakis, M., Mandelbrot, D., & , . (2015). Predonation Direct and Indirect Costs Incurred by Adults Who Donated a Kidney: Findings From the KDOC Study American Journal of Transplantation DOI: 10.1111/ajt.13286