Why aren’t some on dialysis referred for transplants?

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

Pittsburgh Tribune-Review reporters Andrew Conte and Luis Fabregas have released the results of an extensive investigation into kidney transplant and dialysis. Conte and Fabregas found that some dialysis patients hadn’t been told that kidney transplant is an option, even though the procedure, for which patients should get on waiting lists as soon as possible, could add years to their lives. Last year, the duo claimed a top AHCJ award for their work on a similar topic, liver transplants.

The financial consequences of their findings are particularly timely. Kidney conditions account for a fifth of Medicare spending, and “a new kidney costs the federal Medicare program $50,000 less per patient than conventional dialysis,” Conte and Fabregas report.

More than 32,000 of the 105,653 people who started treatment for kidney failure in 2006 were not informed about the option of kidney transplantation, according to the latest available information reported to the Centers for Medicare & Medicaid Services.

Nearly 44 percent of the uninformed simply were not assessed for transplant, the data show. In other cases, patients were deemed to be medically or psychologically unfit for a transplant, or unsuitable because of age.

Private insurers keep dialysis clinics humming

The reporters found that these issues, which have existed for decades, are at least partly attributable to the “inertia” of a system in which dialysis centers need to pull in new patients with private insurance in order to offset the cost of providing dialysis to Medicare and Medicate patients, whose government reimbursements do not cover the full cost of the procedures.

Some doctors say the payment system creates unhealthy incentives for providers to focus on filling their clinics when they should be primarily concerned with making sure patients receive information about transplantation as soon as possible.

Kidney transplants can extend lives by 10 years or more

In this story, Conte and Fabregas continue to build their case. Now that they’ve shown the financial impact of not referring dialysis patients for transplantation, they move on to the human impact. They use numbers, experts and analysis to show why transplantation is a far better decision, healthwise.

Experts: Crucial to get on waiting list as soon as possible

Finally, reporters bring everything together by showing that informing a patient of the possibility of the transplant and getting them on a waiting list is key to ensuring their continuing health.

Related

Washington Post videojournalist Pierre Kattar Jr. tells the story of joining an eight-person kidney donation chain in order to overcome incompatible blood types and donate a kidney to his ailing father, 61-year-old Pierre Kattar Sr. (Hat Tip to kobreGUIDE)

For more on kidney donation chains, see Mat Dowling’s NJ.com multimedia series covering a six-person chain in New York and New Jersey.

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