Trump's order for more action on kidney disease may shrink organ transplant waitlists

Every year, thousands of Americans with kidney failure who could benefit from life-saving transplants can’t get the organs they need.

A record number of people are dying while waiting for an organ to become available that might have saved their lives. An executive order President Donald Trump signed on July 10, 2019 could help some of them.

It calls for taking steps to increase the number of kidney donors, improve care for people with kidney disease, encourage the development of artificial kidneys and more. The intent is to drastically and quickly reduce the number of patients with end-stage kidney disease.

Among other things, the executive order outlines plans to compensate living donors for many of their expenses, make the bureaucracy controlling deceased organ donations more efficient and encourage more preventive care.

As a transplant surgeon, I believe that the new policy could increase incentives Americans have to become organ donors. Coupled with more public awareness about the need, doctors like me could be saving hundreds of thousands more people.

Supply and demand

About 37 million Americans, more than 10% of the entire population, have some form of kidney disease. The most common causes of this disease are high blood pressure and diabetes. Nearly 500,000 of these patients require dialysis, using a machine to carry out the function of the kidneys by filtering toxins out of their blood. Approximately 340 people start using dialysis every day – a big inconvenience because it’s usually done three times a week, for three to four hours at a time.

Only half of those people beginning dialysis today will survive for more than five years. Transplants lead to better long-term survival rates: About 86% of the patients who get a donated kidney live for at least five more years, but each year only about 20% of the Americans waiting for kidney transplants will get one.

Having a transplant from a living donor remains the best option for many patients, as the wait time for a deceased donor organ can be long. But the number of living donor transplants is rising very slowly.

Based on my experience, I believe that a lack of physician and patient awareness of the benefits for the recipient and the minimal risks for the donor may be one reason why kidneys are in short supply. Another issue is the financial burden on donors, who must undergo surgery. They don’t pay for operating costs – that is currently covered by recipient’s insurance – but having the procedure leads to lost wages, and spending on child care, travel and even pet care. That is one problem Trump’s order is designed to alleviate.

Record numbers

Another problem is that there just aren’t enough kidneys to go around. Kidneys for transplantation are distributed based on the number of years a patient has been on dialysis or how long they have been waiting.

Even though a record 21,167 kidney transplants were performed in 2018, most kidney-disease patients currently waiting for an organ won’t ultimately get one because the average wait times exceed their life expectancy.

The federal government oversees the distribution of donated kidneys through United Network of Organ Sharing, an independently run nonprofit, and spends US$114 billion a year on patients with kidney disease through Medicare.

In 2018, transplants from a total of 10,722 deceased organ donors resulted in just 14,725 kidney transplants and 7,849 liver transplants. Many procured organs are discarded because they are not suitable for transplants.

The need for lifesaving organs for transplant far exceeds the demand and the gap has been growing for years.

Liver disease

If the number of organ donors rises as a result of new federal policies, it will also benefit people who need other organs.

For example, roughly 4.5 million Americans have liver disease. This is primarily due to cirrhosis, a condition in which your liver is scarred and permanently damaged – typically from developing long-term hepatitis B or C, alcoholic liver disease or non-alcoholic fatty liver disease.

Early detection, treatment and referrals for a transplant has improved the outcomes for people who do get transplants – either an entire liver from someone who has died or a partial liver transplant from a living donor. Currently 90% of the people who get liver transplants survive for at least one more year and 75% live at least another five years. Yet the death rate for patients with liver disease and cirrhosis who do not get transplants has increased 31% in the past decade.

As more patients and their doctors are understanding the benefits of organ transplantation, greater numbers of patients are being evaluated and placed on waitlists. Today there are more than 121,000 patients waiting for a transplant. Roughly 103,000 need a kidney transplant and more than 13,400 require a liver transplant. Most of the rest require a heart, lung or pancreas.

Amit Tevar receives funding from National Institutes of Health National Kidney Foundation - Medical Advisory Board