Kidney transplantation, whether using organs from deceased or living donors, has been well established as the optimal management for patients with end stage renal disease (ESRD). Unfortunately, it is not nearly as widely available as it should be.
On December 9, 2016, the Rogosin Institute, a full-spectrum kidney care and research organization offering both dialysis and transplantation in New York City, convened a transplant roundtable of 24 experts drawn from multiple sectors from medicine and surgery to media across the United States. Discussants included three individuals who have experienced the benefits of such transplants, one individual waiting for a transplant, and two living kidney donors. The assembled group was charged with determining new ways to overcome the obstacles to the improvement of the rate of kidney donation.
A passion to increase kidney donation clearly emerged from the discussion. Here we provide a brief overview of the facts and challenges to increasing kidney donation, and we present five potential solutions. More details for each proposed solution will be included in future issues of Kidney News.
Although 2016 was a good year for deceased-donor kidney transplants (over 13,000 for the first time), up 11% over 2015, the rate for living donation has not improved at all since it achieved its highest level over a decade ago. Here are some numbers to think about: Only 20% of the half million dialysis patients make it to the transplant wait list, and of those, 5000 die each year waiting. Chronic kidney disease (CKD) is growing, with more than an estimated 26 million Americans affected by it, and it occurs three times more often in the African American community. Dialysis costs Medicare $31 billion annually, and commercial insurers, another $9 billion. It is known that transplant patients live longer and better at a fraction of the cost of dialysis care, and yet the wait list for a kidney is growing each year. Optimally, dialysis should be considered as a bridge to transplant, with the emphasis on finding a living donor for as many ESRD patients as possible
The Rogosin, an independent 501c3 organization, pioneered dialysis in New York in the late 1950s and kidney transplantation in 1963 with a living-related donor transplant program and has been a pioneer participant in the Center for Medicare and Medicaid Innovation’s integrative care model, the End-Stage Renal Disease Seamless Care Organization (ESCO). The institute has held roundtables and symposia on health literacy, quality measures in CKD and ESRD, mental health, nutrition, and the achievement of truly integrated care since 2015.
Roundtable participants included: L. Baxter, recipient/advocate; N.R. Benavides, MS, LiveOnNY; A.W. Bingaman, MD, PhD, Methodist Specialty and Transplant Hospital; Councilwoman J. Bonner (donor); M.B. Charlton, RN, SRN, CCTC, NYP-Weill Cornell Transplant Program; D. Clapper, APRN-BC, MSN, CCRN, CPTC, CTBS, DCI Donor Services; D. Dadhania, MD, MS, FAST, NYP-Weill Cornell Transplant Program; T. D’Antonio, recipient/advocate; T.H. Feeley, PhD, College of Arts and Sciences, University of Buffalo, State University of New York; K.J. Fowler, recipient/advocate; M.L. Ganikos, PhD, Division of Transplantation, Healthcare Systems Bureau, HRSA; P. Hoyt-Hudson, BSN, RN, Center for Health Action and Policy, The Rogosin Institute; S. Kapur, MD, FACS, Transplant Surgery, Weill Cornell Medicine; G.J. Kassar, Office of NY State Senator M. J. Golden; C. Lawson, RN, BSN Reach Kidney Care (TN); T. Loranger, Consultant, The Rogosin Institute; C. O’Leary, PhD, LMSW, Health Literacy Missouri; R.E. Patzer, PhD, MPH, Emory Transplant Center; G. Payne, MS, RN, CNN, Nephrology Clinical Solutions; M. Phillips, MPH, MSW, Center for Health Action and Policy, The Rogosin Institute; D.L. Rudow, DNP, Recanati/Miller Transplant Institute, The Mount Sinai Medical Center; M. Reiner, Renewal in Brooklyn; E. Scheele, ORGANIZE; D. Serur, MD, Kidney and Transplant Program, The Rogosin Institute and NYP-Weill Cornell Transplant Program; J. Sinacore, National Kidney Registry; B.H. Smith, MD, PhD, The Rogosin Institute; A. D. Waterman, PhD, Transplant Research and Education, David Geffen School of Medicine, UCLA.