If you haven’t already, you’ll want to see my prior post wherein I set the stage for why transplants aren’t necessarily cheaper than dialysis. (and PS I failed to mention the growing number of older folks being diagnosed with end-stage renal disease who are choosing not to have any treatment at all.)
Dissecting that explanation matters because as of this past week’s ACOT meeting, a practice that is supposed to be cost-effective (kidney paired donation) suddenly has expenses above and beyond directed living kidney donation.
See slide below:
According to the kidney paired donation workgroup, which includes Dorry Segev, whom I’ve written about before, the above are fees specifically related to kidney paired donation. My observations/explanations:
1. Many would-be kidney transplant recipients have multiple prospective living kidney donors, especially those that publicly solicit (with encouragement from transplant centers). This not something unique to kidney paired donation.
2. NDD = Non-directed donor. The few folks that present themselves as living kidney donors without an intended recipient. The transplant centers tend to use them in chains rather than to facilitate just one transplant – more bang for the buck, I guess? I’ll give them this one.
3. This refers to the fact that while blood type and HLA (antibody) testing only needs to happen once, every possible donor-recipient pair must be checked for sensitivity. In other words, drops of the prospective living kidney donor’s blood must be mixed with the recipient’s blood to see if the recipient’s antibodies will attack it as foreign, signifying the possibility of rejection. This is definitely an added expense
4. Aren’t there already administrative costs to running a hospital? A transplant program? A living donor transplant program? Without some real stats in front of me, I’m not confident running pairs/chains really adds to the burden.
5. This assumes an outside entity will coordinate the entire kidney paired donation program, which would, of course, require employees, infrastructure and the like. Theoretically more than what already exist in the various KPD programs already functioning around the country. Again, debatable.
6. If the kidney donor and recipient are not in the same facility, the kidney must be shipped to the recipient. Except, of course, that deceased donor organs are shipped all the time. And that sometimes one-to-one directed living donor transplants are done at different hospitals too, necessitating a traveling kidney. <- Of course, this is one of the reasons why transplant centers encourage kidney donors to donate at the same center as the recipient. Some of them flat-out lie and tell the LKD it’s not possible to have the surgeries at different hospitals.
7. I’m sorry, what? Surgeons performing the live donor nephrectomy get paid. Are they insinuating that a surgeon should get paid more for participating in a swap/chain? I don’t understand this at all.
8. Yes, because living donors engaged in a traditional directed donation NEVER have expenses related to complications or follow-up.
Tune in to Part III for a prominent appearance by #8…