NKF Applauds New Proposed Rules to Increase Organ Donation

 

“Today the Administration announced two new proposed rules to address the critical organ supply crisis in America by expanding reimbursable expenses for living donors, establishing quality metrics for Organ Procurement Organizations (OPOs) and increasing the supply of transplantable deceased donor kidneys; and the National Kidney Foundation applauds these efforts to help the nearly 95,000 Americans waiting on a life-saving kidney transplant.”

 

“One of the proposed rules announced today will expand financial assistance to living donors under the National Living Donor Assistance Center (NLDAC) to include reimbursing lost wages for donors who take time off from their jobs for donation and recovery and for childcare and eldercare expenses—all of which NKF has advocated for as outlined in A Path Forward for Increasing Kidney Transplantation. These changes will help ensure living donors are made financially whole after giving the gift of life; however, increasing the available pool of resources under NLDAC is critical to ensuring its success and to increasing the pool of living donors. NKF looks forward to working closely with the Administration and Congress to expand the financial resources available to living donors under the NLDAC program. ” 

 

“Another proposed new rule will also put quality metrics in place for OPOs to help encourage the use of less than perfect deceased donor organs, which can still be viable options for patients on the waitlist. A deceased donor kidney transplant, even from a less than perfect kidney, may be better for a patient than remaining on the waitlist and undergoing years of dialysis.” 

 

“NKF’s “Report of National Kidney Foundation Consensus Conference to Decrease Kidney Discards” published in October, 2018, provided the first systematic nationwide approach to reducing kidney discards. NKF has long advocated for reducing unnecessary kidney discards, improving transparency in the organ procurement process, and increasing overall transplant rates; and many of these recommendations are reflected in the Administration’s proposed revisions to the Organ Procurement Organization (OPO) Conditions for Coverage (CfCs).”

 

“Our hope is that these new quality metrics will encourage OPOs to evaluate and procure organs from a larger pool of potential deceased donors, allows for patients to better understand and benchmark OPO performance, and ensure more organs are recovered and successfully transplanted.”

 

The 14 specific recommendations published in the Report of National Kidney Foundation Consensus Conference to Decrease Kidney Discards are as follows:

There are many reasons why kidneys are discarded including poor organ quality, abnormal biopsy findings, prolonged cold ischemic time, anatomy, punitive regulatory and payer sanctions due to poor clinical outcomes, and the increased costs associated with the use of higher kidney donor profile index (KDPI) grafts, the report points out, yet experts believe and data supports that many of these kidneys can be used for transplant. Kidney discard rates also vary upon geography leading experts to believe that the variation may be based on a subjective view of organ viability by an individual transplant team.  Every year kidneys that could be used for transplant are discarded.  In 2016, more than 3,600 were deemed unfit for transplant and thrown away.  But a panel of transplant experts convened by NKF agree that as many as 50% of those kidneys could be transplanted to prolong the lives of Americans otherwise treated with dialysis. The recommendations chronicled in the published report emerged from NKF’s Consensus Conference to Reduce Kidney Discards, held in May 2017 with 75 multidisciplinary experts in the transplant field including kidney patients and families.

 

In the United States, 37 million adults are estimated to have chronic kidney disease (CKD) – and most aren’t aware of it.  1 in 3 American adults is at risk for CKD.  Risk factors for kidney disease include diabetes, high blood pressure, heart disease, obesity, a family history of kidney failure, and being age 60 or older. People of African American, Hispanic, Native-American, Asian or Pacific Islander descent are at increased risk for developing the disease. African Americans are about 3 times more likely than Whites to develop end-stage kidney disease (ESKD or kidney failure). Compared to non-Hispanics, Hispanics are almost 1.3 times more likely to receive a diagnosis of kidney failure.

 

More than 726,000 Americans have irreversible kidney failure, or end-stage renal disease (ESRD), and need dialysis or a kidney transplant to survive. More than 500,000 of these patients receive dialysis at least three times per week to replace kidney function. Approximately 95,000 Americans are on the waitlist for a kidney transplant right now.  Depending on where a patient lives, the average wait time for a kidney transplant can be upwards of three to seven years. Living organ donation not only saves lives, it saves money. Each year, Medicare spends approximately $89,000 per dialysis patient and less than half, $35,000, for a transplant patient.