Dialysis Patients Not Given Transplant Option
Patients with end-stage renal disease are often set up for intensive dialysis treatments without first being given all options available for medical care, according to a review of medical records by the Pittsburgh Tribune-Review.
The newspaper reviewed over 100,000 records of patients who began dialysis treatment in 2006. They found that over 30,000 of those were not informed of the option for kidney transplant in the early stages of treatment. The majority of those patients were deemed medically or psychologically inappropriate for surgery, but the review found that as many as 44% of patients were simply not assessed at all.
According to the Organ Transplant Waiting List, more than 84,000 Americans are waiting organ transplants, with over half of those being kidneys. The United Network for Organ Sharing (UNOS), a nonprofit organization that tracks data, reports that about 16,000 transplant operations are performed each year, with the majority of organs from deceased donors and about 6,000 from live donors.
Kidney transplants can add an average of 10 years to a patient’s life, according to a 1999 study in the New England Journal of Medicine. People ages 20 to 39 received the largest benefit from kidney transplants, gaining 17 years of projected lifespan over those who remained on dialysis.
The amount of time a patient spends on dialysis before receiving a transplant is linked to the success rate of the patient’s new organ, according to a study published in the journal Transplantation in 2002. Five years after receiving kidneys, three-fourths of people who spent fewer than 6 months on dialysis had functioning organs, compared with 58% of those who received treatments for longer than 2 years.
Patients typically start dialysis treatment when they reach the last of five kidney disease stages, when their kidneys reach less than 15% of their filtration function, but federal transplant rules allow patients to be listed before complete failure, when kidneys are at about 20% of function. The median wait time for patients on dialysis before receiving a transplant is about 36 months.
In addition to the increased lifespan, the quality of life is better in patients who no longer have to undergo dialysis treatments. Patients spend 3-4 hours a day, three days a week in hemodialysis. They must follow a strict diet that is higher in protein and lower in sodium, phosphorus and potassium, since these minerals tend to accumulate quickly in the blood. Patients must also limit their fluid intake, since urination is decreased or absent. Infection is common, since permanent access to a vein must be created for the dialysis process, either via a catheter or an Arteriovenous (AV) graft or fistula.
Transplantation is not an option for every dialysis patient. For example, patients with severe coronary artery disease, lung disease or liver disease may disqualify a patient for a transplant. In addition, those with lifestyle behaviors such as alcohol and tobacco use or being morbidly obese might not qualify for available organs. Kidneys are allotted based on a point system that considers factors such as medical urgency, time on the waiting list, blood and tissue type, body size of candidate, and the location of the donor.
New Medicare rules took effect in October require clinics to inform every patient about all of their options, including transplantation. Dr. Allen Nissenson, chief medical officer of DaVita, states that patients are given lists of transplant surgeons and centers within 90 days of starting treatment. Fresenius has a similar policy of assessing all patients and conducting a follow-up examination within 3 months of the initiation of treatment, according to Terry Morris, VP of investor relations and corporate communications.
Overall, Medicare spends more than $17.8 billion a year on dialysis treatments, about 5% of its total budget, according to the US Renal Data System. The federal program spends about $70,000 a year for each patient on dialysis, versus $17,000 a year on someone who receives a successful kidney transplant.
Sources: The Pittsburgh Tribune-Review, United Network for Organ Sharing, The Organ Transplant Waiting List, and The Organ Procurement and Transplantation Network