In June, Yale New Haven Hospital completed one of the largest kidney chain exchanges ever in the U.S, matching nine kidney donors with nine end-stage renal disease (ESRD) patients. This heartwarming story first appeared in the Hartford Courant, highlighting an important, ongoing issue as well as a kidney care innovation. Paired donor transplants, which connect the right kidney patient with the right kidney, are making an impact.
The State of Kidney Transplants
In the U.S. there are more than 112,000 people on the organ transplant waiting list, and more than 93,000 are waiting for a kidney. Each year, almost 5,000 ESRD patients die while waiting, making kidney disease the ninth leading cause of death in our country. On average, 3,000 new people join the kidney waiting list each month.
Kidney disease is a chronic, progressive condition which, left untreated, develops into ESRD, the most serious stage of kidney disease. As of December 31, 2017, there were 746,557 people in the U.S. living with ESRD, a number which climbs by about 20,000 annually.
ESRD is complex and costly to treat. It takes a significant toll on patients, their families, their multi-disciplinary healthcare teams and the health plans providing coverage. Patients living with ESRD require dialysis to survive, a treatment that is life sustaining, but life altering. Dialysis patients must adhere to an extensive medication regimen and dietary restrictions, with their lives typically scheduled around the availability of a chair in a dialysis center. While in-home dialysis, which is less restrictive, less expensive and more flexible, is an option, only 12% of ESRD patients on dialysis receive treatment at home.
In 2017 there were 20,945 kidney transplants performed in the U.S.; of this number, fewer than 28% were from living donors.
Paired Donations: An Innovative Approach to Matching Patients to Kidneys
Paired donations are helping to make a difference. Under programs like the Kidney Paired Donation Pilot Project.
(KPDPP), a program run by UNOS, unos.org a private non-profit contracted by the federal government to manage the nation’s organ transplant system, an incompatible donor and kidney patient are matched with another pair in the same situation. The program, and others like it, help to facilitate the donation and transplant of kidneys for both patients. Altruistic individuals with no connection to an ESRD patient can donate as well, as two women featured in the Hartford Courant article did. This selfless act of generosity can truly transform a life. Patients who receive a kidney transplant typically live longer, return to a more normal life and their overall quality of life improves, as does the long-term cost of care.
More information on kidney donations can be found on the following websites:
In Absence of a Cure, Prevention and Detection
A kidney transplant offers improved quality of life, but it’s not a cure for kidney disease. The best form of treatment remains early detection. Once detected, clinically proven interventions can be introduced to prevent disease onset or slow progression. A simple blood and urine test performed in a doctor’s office as part of a routine annual physical can detect signs of kidney disease.
It is also important to understand the risks to patients and payers. People living with “gateway” conditions, such as obesity and hypertension, are more likely to develop kidney disease. Of those newly diagnosed with kidney disease, two-thirds had one or both of these conditions.
Advanced technology can help slow the growth in the number of people living with kidney disease and ESRD. Robust data resources, artificial intelligence, machine learning and predictive analytics can identify those who are at risk for kidney disease. Then clinically proven interventions can be introduced to slow disease progression. Putting up-to-date, actionable information and individually tailored care recommendations into the hands of providers ensures that patients receive the right care, at the right time and in the right setting. This improves quality of care, outcomes and patient experience.
Healthmap Solutions is at the forefront of kidney health management and has been for over a decade. Our Kidney Health Management program is delivering results, right now, for health plans, their network of providers and their members. Learn more at healthmapsolutions.com.
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 Aubert, Oliver, MD, PhD; Reese, Peter, MD; Benoit, Audry, PhD et al. “Disparities in Acceptance of Deceased Donor Kidneys Between the U.S. and France Estimated Effects of Increased U.S. Acceptance.” Journal of the American Medical Association. 2019; 179 (.