Kidney Failure and the Federal Government (1991) / Chapter Skim
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Access to Kidney Transplantation
Access to Kidney Transplantation
Pages 167-188
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From page 167... ...
There are a number of issues regarding kidney transplantation that the committee did not address. These include, among others, the performance of organ procurement organizations, the effects of required request on organ donation, and the scoring system for the distribution of organs.
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From page 168... ...
Age limits on kidney transplantation have also diminished in clinical importance, although dispute exists about the ethics of using a scarce donated kidney to extend the life of an older ESRD patient when dialysis treatment is available. As an empirical matter, only 193 ESRD patients 65 years of age or older received transplants in 1988 and 178 in 1989 (UNOS, 1990b)
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From page 169... ...
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From page 170... ...
If Stuart's assumptions are correct, perhaps 11,000 to 16,000 patients of the remaining 22,300 new ESRD patients might be suitable transplant candidates, well above the current actual number of procedures being performed. If the estimated need exceeds the available supply, so does the actual demand for kidneys expressed by the length of patient waiting lists.
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From page 171... ...
The second limit on the kidney transplant benefit is that immunosuppressive drugs, which the patient must take to prevent rejection of the transplanted kidney as long as it functions, are currently reimbursed on an outpatient basis for only one year after a successful transplant. These drugs are expensive
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From page 172... ...
Thus transplant patients face a set of predictable and very real needs for medical insurance (Evans et al., 1990~. If they lose their Medicare coverage, their transplant status may be regarded as a preexisting condition by prospective insurers and prevent them from obtaining private health insurance except at
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From page 173... ...
In the long run, the Medicare program should incur lower costs from encouraging kidney transplantation. DISTRIBUTION OF KIDNEY TRANSPLANTS The scarcity of organs limits the number of transplant procedures performed, however, and creates two additional access problems: how to equitably allocate a scarce supply of kidneys, and how to increase the supply of donated organs.
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From page 174... ...
The task force recommended coverage of immunosuppressive drugs (Task Force, 1985) , the implementation of the OPTN, the establishment of a national system for sharing organs, the consolidation of OPOs, a requirement that hospitals ask all prospective candidates about organ donation as a condition of participation in Medicare, and the creation of a scientific registry (Task Force, 1986~.
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From page 175... ...
Blacks received 12 percent of the LRD transplants and 22 percent of cadaver transplants, for 20 percent of the total. Equitable distribution of kidney transplants has emerged as an important issue, especially with publication of a report from the DHHS Office of Inspector General (GIG, 1990)
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From page 176... ...
population; their incidence of renal failure is nearly four times that of whites. Regarding kidney transplantation, black ESRD patients represent about 30 percent of those on waiting lists but wait nearly twice as long to obtain a kidney as do whites; they receive over 22 percent of cadaver transplants and 12 percent of LRD transplants (UNOS, 1990b)
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From page 177... ...
Finally, the Transplant Amendments Act of 1990 called for a study by the General Accounting Office to determine "the extent to which the procurement and allocation of organs have been equitable, efficient, and effective." In addition to the level of sensitization, the UNOS point scoring system, and race, economic factors have also been suggested as sources of disparities in access to transplantation. However, income and health insurance as economic barriers to transplantation have not yet been adequately addressed.
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From page 178... ...
These data suggest that transplant patients are more likely to have private health insurance than are dialysis patients. Although no national data are available on the private health insurance status of prospective transplant candidates, it is possible that the availability of private insurance affects the willingness of a prospective patient and of a transplant center to conduct the procedure.
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From page 179... ...
A commonly cited figure, regarded as overly optimistic on the basis of recent studies, is that of 25,000 potential donors per year (AMA, 1981~. A recent study of the brain death and organ donor potential for Pennsylvania estimated that the potential pool was between 38.7 and 55.2 donors pmp, depending on the stringency of criteria of organ suitability.
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From page 180... ...
It is not clear, however, what effect these advances have had on organ donation. The effect of traffic safety measures on organ donation is often mentioned but seldom analyzed.
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From page 181... ...
Data developed by the IOM ESRD study staff suggest that the novelty of organ transplantation may have worn off and that the story may be less newsworthy.4 The attitudes of professional caregivers generally favor donation (Prottas and Batten, 19881. Recent studies, however, show substantial ignorance among neurosurgeons about brain death, a critical factor affecting organ
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From page 182... ...
The requirement that hospitals have written protocols for asking about organ donation, although well intentioned, may have altered the character of the request for organ donation. Cadaver donation involves a complex process between the attending physicians and nurses caring for the recently deceased potential donor, the organ procurement professionals, and the family of the deceased.
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From page 183... ...
Renewed efforts to increase the supply of donated organs should be balanced, therefore, by careful design, testing, and data acquisition regarding all proposed interventions, and by extensive professional and public discussion about the social, cultural, and religious values that are involved in donation. The committee believes that increasing the supply of donated kidneys for transplantation should receive very high priority, both from the medical community and from the federal government.
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From page 184... ...
The committee recommends that the Centers for Disease Control conduct a national study of the potential donor pool, with attention to the estimated effects of AIDS, improved trauma care, traffic safety legislation, and other pertinent factors. Two highly controversial ideas are likely to receive continuing public discussion and debate.
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From page 185... ...
1988. Access to kidney transplantation: Has the United States eliminated income and racial differences?
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From page 186... ...
1990b. Annual Report on the Scientific Registry for Organ Transplantation and the Organ Procurement and Transplantation Network, 1988 & 1989.
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From page 187... ...
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