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

Categories
Follow-Up Liver Donor Living Donor Research Living Donor Risks Living Kidney Donor

American Society of Transplant Surgeons Winter Symposium 2015 Abstracts

Read ’em all here folks: http://onlinelibrary.wiley.com/doi/10.1111/ajt.13164/pdf

 

Long-Term Living Donor Outcomes: When To Say No Dorry Segev (Pg. 43).

“The risks of donation are real. And serious. And attributable to donating. In other words, there are things that might happen to an individual if he donates that would not happen to that individual had he not donated”

And

“And of course it will only get worse. No doubt as we follow the new cohort of donors with more medical issues (higher BMI, higher blood pressure, etc.) for much longer periods of time (current follow-up in large studies is relatively still “short-term” or “medium-term”), we will discover much more risk that donors take.”

 

Note: We/They aren’t following anyone. There is no living donor registry; we don’t even have one-year of comprehensive living donor data.

***

Non-Academic Transplant Business Intelligence – A Surgeon’s Perspective Robert Osorio (pg 47).

” transplant professional societies now host career development seminars to improve business intelligence among their membership. The paucity of literature is also improving, and reviews are now available regarding the finances of transplantation”

and

“In 2008, ASTS launched the first comprehensive compensation study for transplant surgeons practicing within the United States4 . These results have provided a better understanding of total compensation, including salary and benefits, of academic staff surgeons, program directors, and academic transplant surgeons in leadership positions. This type of study is readily used in compensation agreements requiring fair market value (FMV) estimates of salary for non-academic transplant surgeons who are in an employed model”

***

Eliminating the Significant Regional Variation in Donor Conversion Rates Provides the Most Significant Reduction To Waitlist Mortality. (pg 49)

” Redistricting might reduce waitlist mortality and potentially saves 563 lives over 5 years. Here we examine national donor conversion rates and waitlist opportunities.”

***

Hypertension and Diabetes in Live Kidney Donors and Matched Nondonors (pg 55).

“Living donors had lower diabetes than matched controls immediately after donation, but higher incidence past 10 years. Living donors had substantially higher long-term risk of diabetes. Risk of hypertension increased more quickly over time for black donors than nonblack donors. Hypertension incidence did not differ between donors and controls.”

***

Patterns of Physician Visits Before and After Living Kidney Donation (pg 66)

“Smokers, donors with less than college education, and male donors (particularly single men) are less likely to visit a PCP annually after-donation, and may benefit from targeted efforts to improve PCP followup.”

***

Predonation Characteristics Associated With Risk of End-Stage Renal Disease in Live Kidney Donors (pg 70)

“Obese donors and those with a high blood pressure have signifi – cantly higher 15-year risk of ESRD compared with other donors.”

**

Outcomes After Right Kidney Living Donor Transplant Are Associated With Center Volume (pg 76)

“RKLDT [Right Kidney Living Donor Transplant] is associated with a higher rate of GF [Graft Failure} among centers performing <12 RKLDT annually, whereas there is a 2-fold reduction in the RR of GF among experienced centers ( >12 RKLDT /year).”

**

Analytic Morphomics Do Not Predict Long-Term Outcomes in Living Kidney Donors (pg 83)

“Survey results were obtained from 598 living kidney donors (response rate 57.6%). The mean follow-up time from donation was 9.1 years. “

And

” however, 17.0% of patients reported new diagnosis of at least one significant cardiovascular risk factor including: diabetes(2.5%), hypertension(14.0%), kidney disease(1.0%), heart attack(0.3%), and stroke(1.3%).”

 

Categories
Living Donor Research Living Kidney Donor

Not All Living Kidney Donor Kidneys Are Created Equal

Our authors looked at the effect of single kidney glomerular filtration rate and/or donor/recipient body surface area ration affected graft function post-transplant.

Give the whole study a read here: http://informahealthcare.com/doi/abs/10.3109/0886022X.2015.1007805

But in short, they found that SKGFR <40 is a problem, as is D/R BSA <0.8. The larger the donor/recipient body surface area ratio the better in terms of post-transplant graft function, apparently.

 

ETA: In layperson’s terms, this means that a kidney from a smaller living donor doesn’t do well in a larger recipient.
Jinfeng, L., Jia, L., Tao, G., Wenjun, S., Xinlu, P., Yonghua, F., & Guiwen, F. (2015). Donor kidney glomerular filtration rate and donor/recipient body surface area ratio influence graft function in living related kidney transplantation Renal Failure, 1-6 DOI: 10.3109/0886022X.2015.1007805

Categories
Living Donor Research Living Donor Risks Living Kidney Donor

Kidney Donors Over 60 Have Good Recipient Results

A single transplant center analysis of 181 living kidney donors categorized by age revealed that “donor age…was not a risk factor for patient or graft survival”.

The death-uncensored graft survival rates in the 3 subgroups (.39; 40-59; 60+) were 64.5%, 76.0% and 90.9%, respectively, whereas their mean estimated glomerular filtration rates 1 year after transplantation were 40.7 ± 7.4, 41.0 ± 10.7 and 51.4 ± 14.3 ml/min/1.73 m2, respectively (p=0.025).

In other words, using kidneys from living donors 60+ years of age for recipients 60+ years of age produces the best results (as opposed to 60+ LKDs for younger recipients).

 

According to the USRDS, the average age of end-stage renal disease onset is 64.4 years old, so why shouldn’t their “replacement” kidney be approximately the same age? Older donors will be screened for (and free of) the chronic conditions that won’t have yet appeared in younger LKDs (diabetes, heart disease, kidney disease), because those conditions don’t rear their heads until a more advanced age, Also, the  long-term risks of living kidney donation (heart disease, kidney disease, bone disease) won’t have time to take root in LKDs over 60.

According to the US census, 19.2% of the US population in 2012 was 60 years of age and older; another 27.5% is 40-60 years of age. Over the next twenty years, it is this second group that will need kidneys far more than anyone else. Unless US population tides shift, there simply won’t be enough younger people to use as their medical supply.

 

Of course, the best and only solution is to implement robust prevention and treatment programs for kidney disease, but until then, maximizing utilization will have to do.

 
Tanaka, S. (2014). Old-for-Old Age Matching in Living Donor Kidney Transplantation: A Single-Center Experience Journal of Transplantation Technologies & Research, 04 (02) DOI: 10.4172/2161-0991.1000141

Categories
Deceased Organ Donation Transplant Wait List

Transplant Wait List Watch 2014

Yeah, it’s been a hot minute since I did one of these, but a recent conversation motivated me.

 

Active wait list candidates today, September 21, 2014: 79,127. 

That’s a 9.4% increase since April 29, 2011.

 

BTW, there’s 108,989 total kidney wait list registrations (active and inactive). 16,054 (14.7%) have had a prior kidney transplant. Meanwhile, there are 101,244 candidates and 14,493 (14.3%) have had a prior kidney transplant.

This means the kidney wait list contains 7745 multiple listings, aka folks listed at multiple centers. Think Steve Jobs.

 

Prior check-ins:

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

 

In case you don’t know, these numbers are available at OPTN’s website.