Executive order is chance to expand kidney donation, JAMA article says

Members of the University Transplant Center, a clinical partnership of UT Health San Antonio and University Health System, authored a viewpoint piece published Sept. 20 in the Journal of the American Medical Association. In the article, Elizabeth Thomas, D.O., Jennifer Milton, RN, M.B.A., and Francisco G. Cigarroa, M.D., discussed the Advancing American Kidney Health Executive Order signed in July by President Donald Trump. They deem it an important opportunity to enhance organ donation.

Elizabeth Thomas, D.O., left, and Jennifer Milton, RN, M.B.A., of the University Transplant Center

“The executive order must be recognized for opening the conversation surrounding the burden of kidney disease in the United States, establishing policies to decrease the incidence of kidney failure, and improving the quality of life through research and more effective strategies,” the authors wrote. “But the order should also be used as an important opportunity to improve living donor support and expansion, and to maximize deceased donor organs.”

Encouraging living donors

Living donors who give a kidney to a family member or other person with end-stage kidney disease often spare the recipient from requiring dialysis, which is estimated to cost health care systems $89,000 per patient per year once dialysis has begun, the authors wrote. Living donor kidney transplants also lead to better outcomes, with five- and 10-year kidney graft survival rates exceeding those of patients who receive kidneys from diseased donors.

Campaigns to educate the public about the importance and safety of living kidney donation are needed for donation rates to improve, the authors wrote. The executive order tackles financial burdens many living donors face such as lost wages, travel costs and other expenses, but the authors highlighted the need to also ensure living donors have adequate insurance coverage for any medical needs after donation.

“The need to better support living donors is important not only to reduce the burden of end-stage organ failure, but also from the obligation of the community to support those generous individuals willing to be donors,” the authors wrote. “Their gift is a sacrifice that deserves gratitude.”

Maximizing deceased-donor organs

Francisco G. Cigarroa, M.D., director of the University Transplant Center, speaks at the recent opening of the Laredo transplant clinic.

The executive order “introduces strategies to improve the use of organs from deceased donors, but more can be done,” the authors said. Expanding the number of people who opt in to become registered donors at the time of their death should be the subject of educational campaigns and even encouragement of registration via smartphone apps, the authors wrote.

Measures should be taken to increase transplants from deceased donors by better utilization of allocated kidneys, including high KDPI kidneys or from donors designated as increased risk by the U.S. Public Health Service, the authors wrote. KDPI, short for kidney donor profile index, is a summary of the risk of kidney graft failure based on multiple donor factors.

To reduce the number of unused organs, transplantation programs would benefit from access to high-quality biopsies to rapidly evaluate the organs. In addition, the authors wrote, “Physicians and patients should understand that the benefits of good organ function far outweigh the risks of infection in the majority of cases.”

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