Transplant Referrals from For-Profit Versus Nonprofit Dialysis Centers Stoke Controversy

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Patients with kidney disease who are treated at for-profit dialysis centers are 20 percent less likely to be informed about the transplantation option than are those at nonprofit centers, according to a study at Johns Hopkins University School of Medicine. Controversy about this finding played out recently during a forum in Oregon, when angry state insurers and others confronted representatives from for-profit dialysis centers about the transplantation option.

“In order to be transplanted, you need to be referred by your dialysis center, and in many cases that just isn’t happening,” said Dorry Segev, MD, PhD, who published the study in the American Journal of Transplantation.

Factors other than treatment at for-profit dialysis centers appeared to also affect who got information about other care or treatment options. Older, obese, uninsured, and Medicaid patients were less likely to be informed about all their options, including transplants, the study showed. These omissions have a genuine impact on health, because overall, the uninformed were 53 percent less likely to be placed on a waiting list for a new organ or to receive a kidney from a living donor, according to the study.

In Oregon, dialysis bills for the Oregon Medical Insurance Pool (OMIP) had nearly tripled from $7 million to more than $20 million in the previous 3 years, so the OMIP board in early January publicly questioned executives from the two largest for-profit dialysis companies, Fresenius and DaVita, and the American Kidney Fund (funded in part by those companies), which gives treatment-related financial assistance.

The OMIP is the high-risk health insurance pool for the state. It was established by the Oregon legislature to cover adults and children who cannot get traditional medical insurance because of their health conditions.

OMIP board members were concerned about sharply rising costs and the kidney fund’s cessation of premiums for patients who went on to get transplants.

LaVarne Burton, president and CEO of the kidney fund, defended the practice, saying that the kidney fund has limited resources and could pay for dialysis premiums but not for premiums that would cover a transplant, related drugs, and subsequent care, according to Nick Budnick of the Portland Oregonian. Burton said that the nonprofit funding organization considers dialysis patients to be the neediest patients.