Saving Lives While Saving Money: The Living Kidney Donor Support Act would benefit tens of thousands of Americans and save billions of tax dollars.

• Author: Brannon, Ike
• Position: HEALTH & MEDICINE

The United States does not have enough transplant kidneys to provide one to each person suffering from end-stage kidney disease who would benefit from a transplant. This shortage is costly to the people who end up waiting longer for transplant or who die awaiting one; to taxpayers, who pay most of the health care costs of people with end-stage kidney disease; and to the broader economy, which loses the talents of people suffering from kidney failure.

In 2022, U.S. hospitals performed 25,000 kidney transplants. About 6,000 of the organs came from living donors. Over 500,000 people are currently on dialysis and nearly 100,000 are on a transplant waiting list. An estimated 30 percent of transplants are pre-emptive: if not for the transplant, the recipient would go on dialysis.

Many good candidates for transplant are not placed on the waiting list. Some are discouraged from going to the trouble and expense of being evaluated to receive a deceased donor kidney. Some physicians hesitate to refer patients for evaluation to spare them the risks of some diagnostic procedures (such as a coronary angiography) and the disappointment of not being approved for the list. Most transplant centers use stringent criteria for placing patients on the list to increase the likelihood of successful transplants.

Dialysis is costly. Medicare spends nearly $ 100,000 per year for each dialysis patient it covers. It spent over $130 billion treating kidney disease in 2022. Private insurers also paid billions of dollars to cover the costs of dialysis for their enrollees. Patients with end-stage kidney disease constitute less than 1 percent of the Medicare population but account for 7 percent of the Medicare budget.

What's more, the debilitating effects of kidney disease are not eliminated by dialysis, which is life-sustaining but imposes large costs. Most dialysis patients, regardless of age, find it makes them too fatigued to work. Dialysis patients also have a shorter life expectancy and greater health costs (beyond dialysis) during their remaining years than those who receive a kidney transplant.

THE LIVING KIDNEY DONOR SUPPORT ACT

In recent years there have been efforts to boost the number of kidneys available for transplantation. A promising effort is recent draft legislation called the Living Kidney Donor Support Act. It contains three major provisions to boost the number of kidneys from living donors.

Education campaign / The legislation would fund a national education campaign to inform the public about the need for kidney donations and opportunities to make living donations. It would note that donating a kidney is generally safe and publicize the benefits for the donor and recipient of saving a life through donation. This campaign would be run by a contractor and would train individuals and medical professionals in instructional outreach about the need for kidney donations.

One potential model for such a campaign is Be the Match, the federally contracted organization that operates the national bone marrow program. In addition to providing extensive information on its website, Be the Match offers information and support for potential donors throughout the country. It organizes informational sessions in numerous communities where someone needs a bone marrow transplant. After the presentation, the organization provides for testing people to determine whether they might be a match for the potential recipient and be added to the national donor database. If the potential donor is a match, he is asked if he wishes to explore donating. If so, Be the Match arranges for the initial tests. It also provides someone akin to a patient navigator (explained below) to help the donor through all steps from medical testing to marrow recovery (returning to normal levels of marrow after donation). Not-for-profit entities currently operate similar programs for kidneys on a local basis, but a national educational effort would be better.

Navigator office / The legislation would also create a living kidney donor navigator program. The program would train people to help potential donors, who often face time-consuming tests to determine their suitability for organ donation. Travel to testing sites can range from a few miles to hundreds of miles, depending on where the recipient is awaiting transplant. Having a navigator who could request that tests be done in a place convenient for the donor and streamline testing to avoid repeat visits to the transplant hospital could lessen the costs of donation.

Besides streamlining medical testing prior to surgery, a patient navigator could provide other assistance to donors before and after surgery. Navigators would be employed by federally contracted nonprofit organizations.

Several nonprofits already help facilitate kidney donations and have navigator-type staff. They are largely financed by private donations and to some extent by hospitals that receive the organs to do the transplant. Unfortunately, this assistance is not widely available throughout the country. The legislation would scale up these programs into a national system.

Reimbursing donors' costs / The legislation includes a provision to reimburse donors for non-medical expenses incurred during the donation process. (Medical costs typically are covered by the recipient's insurance.) Such expenses fall into three broad categories: out-of-pocket expenses such as food, lodging, and travel; lost wages during testing, the operation, and recovery; and childcare or elder care costs that a donor's family may need...