The KTC Solution
Today, there are two primary treatments for the disease — Dialysis or Kidney Transplant
How can we support? Advocate and Educate.
Policy/Advocacy
Living Donor Rates Are Stagnant: There are two sources for kidney transplants: kidneys donated by deceased donors, and those donated by living donors.
Living donor organs are preferrable for two reasons:
“Given that only about 1% of deaths occur in a manner suitable for organ donation, there appears to be no possibility that any further increase in deceased donation will be sufficient to eliminate the shortage. Similarly, there is currently a considerable emphasis on minimizing the number of deceased donor kidneys recovered but not transplanted; however, at best, that alone might result in approximately 2000 more transplants per year, a mere dent in the problem
Matas AJ, Montgomery RA, Schold JD. The Organ Shortage Continues to Be a Crisis for Patients With End-stage Kidney Disease. JAMA Surg. 2023 Aug 1;158(8):787-788. doi: 10.1001/jamasurg.2023.0526. PMID: 37223921
Adding facilitators could radically change that figure, and drastically increase living donation, so that 49 of the 100 candidates actually complete the donation.
Elevating Patient Navigation for the Living Donor and Recipient
Clinical studies demonstrate how living donor transplantation can increase by providing a transplant facilitator to the potential recipient and the potential donor to support identifying qualified donors and supporting the complex pre–donation and donation process.
Assisting Potential Recipients in Identifying Donors
Expecting advanced CKD and ESKD patients to find living donors isn’t a stable solution. Studies have shown that dialysis patients working with a transplant facilitator to arm them with the language to ask, identify potential donors, and in some cases even initial the outreach for the potential recipient, significantly increase the likelihood that a living donor can be found. By implementing a transplant facilitator, The Johns Hopkins “Champions” program reported a massive increase in recipients identifying living donors following the assistance of a facilitator.
Assisting Potential Donors in Navigating the System
Providing individuals who volunteer to be considered for living donation a facilitator provides necessary support to understand the extensive medical testing and eventual surgery. This support has also shown an increase in prospects of living donation. Today only 7 candidates of every 100 potential living donors willing to be screened make it to donation.
Kidney Transplant Is the Optimal Treatment – Both from a Health and Fiscal Perspective: Kidney transplant is the “optimal treatment.”
The health benefits of transplants are enhanced by the cost savings. A private study, using Congressional Budget Office scoring conventions, estimated each kidney transplant saves the Medicare program $800,000 over ten years. Adding 6,000 new living donor transplants over the next decade would reduce Medicare spending by $6.6 billion.
“Although not a cure for kidney disease, a transplant can help a person live longer and improve quality of life. On average, patients experience 14 to 16 years of function from a kidney from a living kidney donor, while few people survive more than a decade on dialysis.”
Medicare Program; Alternative Payment Model Updates and the Increasing Organ Transplant Access (IOTA) Model, 89 Fed. Reg. 96280, 96294 (December 4, 2024).
Advocating for enhanced cost reimbursement for living donors will support an increase in living donor transplants.
Modify the 2024 physician fee schedule which created a direct payment program for “Principal Illness Facilitators,” principally in the oncology and respiratory arenas, through which physicians could be reimbursed for hiring facilitators to assist patients through treatment.
CMS could amplify the existing Principal Illness Navigator program and create a specialized Living Kidney Donor Transplant Facilitator program for ESKD and advanced CKD patients who are potential transplant recipients and for the prospective living donors who are prepared to help them. The regulation would need to only include four proposals:
Modification 1. Clearly include patient facilitation for recipients as viable reimbursable activity, removing any room for interpretation, to include assistance in finding a living donor.
Modification 2. Establish patient facilitation for living donors as viable reimbursable activity.
Modification 3. Increase the existing program’s payment rate so as to support the specialized services needed for living donation facilitation.
Modification 4. Clarify the 2024 statement that co-pays must be made and state that potential living donors are not responsible for copays.
Grants
It is essential that the kidney transplant community continue to aggressively explore innovative new kidney transplant methods, strategies and programs that can be implemented at the state, regional and federal level to significantly increase kidney donation and transplantation.
Pulsatile Perfusion of Kidneys from Procurement to Delivery at Accepting Centers
Using Machine Learning Predictions to Improve Utilization and Reduce Discards in Deceased Donor Organ Allocation
Kidney Transplant in Rapid Organ Recovery from Donation after Uncontrolled Circulatory Death Occurs
Private Sector
