Transplant Policy
8/1/2010
Transplant games kicked off this weekend
By Lora Wilson
The 2010 National Kidney Foundation U.S. Transplant Games opened Saturday in Madison, Wisconsin. More than 5,000 organ recipients, living donors and donor families gathered to look back at a 20-year retrospective of the games, Miracles and Milestones, and forward to healthy futures made possible by organ donation. Individuals were chosen to represent each biennial event from 1990 in Indianapolis to the 2008 games in Pittsburgh.
The opening ceremonies were co-hosted by NKF CEO John Davis and Living Donor and FOX New Anchor, Catherine Herridge, with appearances by kidney recipient, actor and NFK Chancellor, Ken Howard, liver recipient and actor, Larry Hagman, transplant pioneer Dr. Hans Sollinger, and Wisconsin Governor, Jim Doyle.
Forty-two teams, proudly sporting their team's colors and crazy gear unique to their home regions, represented every part of the United States, along with international squads from Brazil, Canada, Japan and Sweden. Hosts, Team Wisconsin, were stylish in uniforms featuring their iconic cows and, of course, cheese. Having triumphed over life-threatening diseases, these recipient athletes are already winners; this celebration was their collective victory lap.
Double-lung recipient Isabel Stenzel Byrnes blew the crowd away with her rendition of the National Anthem on the bagpipes.
Earlier in the day, donor mom Holly Campbell was finally able to meet and hug the boy who as an infant received her young son's heart. She sang "For Good" as we watched photos of her boy, Jake. Truly the refrain of that song captures the essence of the miracle celebrated in Madison this week: "Because I knew you, I have been changed for good."
More than 1,200 transplant recipient athletes, from two years old to 85, will compete in 13 different sports including track and field, bowling, cycling, golf, swimming, basketball, volleyball and tennis. For the first time, living donors will be eligible to compete in certain track and field events. The games conclude with closing ceremonies on Tuesday evening.
Olympian Chris Klug and sponsor Novartis' Marion Martin were honored to light the torch for the 2010 US Transplant Games, as crowd chanted in unison, "Let the games begin!"
The 2010 National Kidney Foundation U.S. Transplant Games opened Saturday in Madison, Wisconsin. More than 5,000 organ recipients, living donors and donor families gathered to look back at a 20-year retrospective of the games, Miracles and Milestones, and forward to healthy futures made possible by organ donation. Individuals were chosen to represent each biennial event from 1990 in Indianapolis to the 2008 games in Pittsburgh.
The opening ceremonies were co-hosted by NKF CEO John Davis and Living Donor and FOX New Anchor, Catherine Herridge, with appearances by kidney recipient, actor and NFK Chancellor, Ken Howard, liver recipient and actor, Larry Hagman, transplant pioneer Dr. Hans Sollinger, and Wisconsin Governor, Jim Doyle.
Forty-two teams, proudly sporting their team's colors and crazy gear unique to their home regions, represented every part of the United States, along with international squads from Brazil, Canada, Japan and Sweden. Hosts, Team Wisconsin, were stylish in uniforms featuring their iconic cows and, of course, cheese. Having triumphed over life-threatening diseases, these recipient athletes are already winners; this celebration was their collective victory lap.
Double-lung recipient Isabel Stenzel Byrnes blew the crowd away with her rendition of the National Anthem on the bagpipes.
Earlier in the day, donor mom Holly Campbell was finally able to meet and hug the boy who as an infant received her young son's heart. She sang "For Good" as we watched photos of her boy, Jake. Truly the refrain of that song captures the essence of the miracle celebrated in Madison this week: "Because I knew you, I have been changed for good."
More than 1,200 transplant recipient athletes, from two years old to 85, will compete in 13 different sports including track and field, bowling, cycling, golf, swimming, basketball, volleyball and tennis. For the first time, living donors will be eligible to compete in certain track and field events. The games conclude with closing ceremonies on Tuesday evening.
Olympian Chris Klug and sponsor Novartis' Marion Martin were honored to light the torch for the 2010 US Transplant Games, as crowd chanted in unison, "Let the games begin!"
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3/2/2009
'End the Wait!' offers comprehensive solution to organ shortage
By John Davis
Mr. Davis is CEO of the National Kidney Foundation, based in New York City.
Organ transplantation has always been a topic of interest, both for the public and for the medical community, since the first transplant took place in 1954. But it has been a star-crossed procedure touted as a "gift of life" with access hampered by the terrible shortage of organs and the long wait that faces many Americans to get a transplant.
The National Kidney Foundation has been involved in improving the lives and health of kidney patients for decades. We have supported and led many positive initiatives that have made a difference in the success of transplantation. Yet, some recent news coverage has focused on what our organization is against, rather than what we are for.
At its January meeting, the NKF Board of Directors committed itself to changing that perception. We are speaking out about what we are working toward, and we have set our sights very high. Our goal is everyone's goal, the patients, the professionals, the organ donors, and the payers.
Within the next 10 years, we want to end the wait for a kidney transplant.
We can take steps right now to reach this goal. Working on small problems and dealing with single issues won't get us there. This plan will.
Each of our recommendations have already been tested and proven. They are in place for some, but should be used by everyone.
Implementing "End the Wait!"
1. We want to help transplant recipients keep the organs they have, so we should pay for the vital immunosuppressive medicines they need for the rest of their lives. Medicare now stops the coverage for many after three years. Recipients can be healthier and better cared for if they receive the medications they need. If we do the right thing for all, a wait won't be needed twice.
2. We want to improve the care provided to families of decreased donors, and make more organs available. We should guarantee donor families that all donation- related costs of their loved one's hospital stay and funeral will be covered. We should use marginal organs that aren't perfect, but can sustain the lives of some of those who are waiting. These things are done for some, they need to be available nationwide.
3. Living donors offer the largest and most beneficial source of organs for kidney transplants. Their gifts restore health and add years of productive life for thousands now. It can be thousands more. Donor expenses should be fully covered, even lost wages. Organ retrieval is now done with small incisions for faster and less painful recovery for some; such procedures should be available everywhere. Matched donations via a donor pool are beneficial for recipients with a willing but incompatible donor. They are common in some places and should be established everywhere. And, we should guarantee donors health care coverage and life insurance for anything that happens because of the donation.
These are the three steps the NKF believes need to be taken to End the Wait, and they can be done. A complete list of NKF's recommendations is available at www.kidney.org. Those who are on the wait list now need us to build a comprehensive framework to reach the real goal. We all agree on it, so lets do it. In 10 years, we can End The Wait!
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11/25/2008
Allocating organs: an opportunity to make a difference
M. Jill McMaster
The time to influence future policy on how deceased donor kidneys are allocated will never be better than right now. Between now and December 18th, kidney transplant professionals and the public have an opportunity to comment on "Kidney Allocation Concepts: Request for Information," a document of the Kidney
Transplantation Committee of the Organ Procurement and Transplant Network/United Network for Organ Sharing (OPTN/UNOS). This detailed document is available on OPTN and UNOS Web sites and poses specific questions to guide the discussion about the concepts being considered for a future kidney allocation system.
Current practice
Many people involved in kidney transplantation agree that the current kidney allocation policy needs to be changed. Tissue matching between donor and recipient, once critical, now is of less importance. Time on the kidney transplant waiting list has become a primary factor in allocation rather than time on
the waiting list, balanced with medical criteria. Under the current system, organs are not necessarily allocated to candidates who will receive the greatest benefit.
Over the last four years, the OPTN/UNOS Kidney Transplantation Committee has studied this problem. The committee is now examining a kidney allocation system that would require a Kidney Allocation Score (KAS) be calculated for each transplant candidate whenever a deceased donor kidney is available. This scoring process differs significantly from the allocation process used today. The new formula for calculating the Kidney Allocation System (KAS) score would look like this:
KAS = LYFT x 0.8 x (1-DPI) + DT x (0.8xDPI+0.2) + (CPRA x 4/100)
The formula incorporates three significant components:
1. Life Years From Transplant (LYFT)The LYFT is the (estimated survival with a transplant from available donor) minus (estimated survival on dialysis). There are more than 15 variables imbedded in the LYFT formula, including age, years on dialysis, BMI, diabetes status, previous transplant, histo-compatibility factors, calculated panel reactive antibody, and diagnosis of polycystic kidney disease.
Donor-related variables that affect LYFT include age, cause of death, CMV serology, hypertension, and weight. Information from candidates and donors is combined to determine the degree of tissue matching.
2. Donor Profile Index (DPI). The DPI provides a continuous measure of a donated organ's quality based upon clinical information. The objective of this component is to provide a more precise metric for deciding which organs are appropriate for which candidates. Primarily, the deceased donor's physical characteristics determine the DPI. For example, factors in the DPI calculation include age, gender, weight, creatinine level, history of smoking, hypertension or diabetes. The cause of death is also a factor.
3. Dialysis Time (DT). The number of days a candidate has spent receiving dialysis treatments will be incorporated into the formula. The amount of influence DT has on the candidate's score is determined by the quality of the donated organ. For the best quality organs, DT will have minimal impact. As the quality of the organs decreases, the impact of the DT factor increases.
Conclusion
Public input is critical to the development of the kidney allocation policy. Tens of thousands of lives will be impacted. The 28-member OPTN/UNOS Kidney Transplantation Committee has worked hard and now seeks additional input. Please, spend the time, consider the options, and provide feedback to the committee by Dec. 18.
Ms. McMaster is the vice president for Patient and Donor Affairs, Organ Procurement Transplant Network/United Network for Organ Sharing, Board of Directors. UNOS is based in Richmond, Va.
Look for additional information on KAS in Ms. McMaster's column in the December issue of NN&I.
The time to influence future policy on how deceased donor kidneys are allocated will never be better than right now. Between now and December 18th, kidney transplant professionals and the public have an opportunity to comment on "Kidney Allocation Concepts: Request for Information," a document of the Kidney
Transplantation Committee of the Organ Procurement and Transplant Network/United Network for Organ Sharing (OPTN/UNOS). This detailed document is available on OPTN and UNOS Web sites and poses specific questions to guide the discussion about the concepts being considered for a future kidney allocation system.
Current practice
Many people involved in kidney transplantation agree that the current kidney allocation policy needs to be changed. Tissue matching between donor and recipient, once critical, now is of less importance. Time on the kidney transplant waiting list has become a primary factor in allocation rather than time on
the waiting list, balanced with medical criteria. Under the current system, organs are not necessarily allocated to candidates who will receive the greatest benefit.
| To obtain a copy of Kidney Allocation Concepts: Request for Information,visit www.unos.org/kars.asp. E-mail responses by Dec. 18 to kidneypolicy@unos.org |
Over the last four years, the OPTN/UNOS Kidney Transplantation Committee has studied this problem. The committee is now examining a kidney allocation system that would require a Kidney Allocation Score (KAS) be calculated for each transplant candidate whenever a deceased donor kidney is available. This scoring process differs significantly from the allocation process used today. The new formula for calculating the Kidney Allocation System (KAS) score would look like this:
KAS = LYFT x 0.8 x (1-DPI) + DT x (0.8xDPI+0.2) + (CPRA x 4/100)
The formula incorporates three significant components:
1. Life Years From Transplant (LYFT)The LYFT is the (estimated survival with a transplant from available donor) minus (estimated survival on dialysis). There are more than 15 variables imbedded in the LYFT formula, including age, years on dialysis, BMI, diabetes status, previous transplant, histo-compatibility factors, calculated panel reactive antibody, and diagnosis of polycystic kidney disease.
Donor-related variables that affect LYFT include age, cause of death, CMV serology, hypertension, and weight. Information from candidates and donors is combined to determine the degree of tissue matching.
2. Donor Profile Index (DPI). The DPI provides a continuous measure of a donated organ's quality based upon clinical information. The objective of this component is to provide a more precise metric for deciding which organs are appropriate for which candidates. Primarily, the deceased donor's physical characteristics determine the DPI. For example, factors in the DPI calculation include age, gender, weight, creatinine level, history of smoking, hypertension or diabetes. The cause of death is also a factor.
3. Dialysis Time (DT). The number of days a candidate has spent receiving dialysis treatments will be incorporated into the formula. The amount of influence DT has on the candidate's score is determined by the quality of the donated organ. For the best quality organs, DT will have minimal impact. As the quality of the organs decreases, the impact of the DT factor increases.
Conclusion
Public input is critical to the development of the kidney allocation policy. Tens of thousands of lives will be impacted. The 28-member OPTN/UNOS Kidney Transplantation Committee has worked hard and now seeks additional input. Please, spend the time, consider the options, and provide feedback to the committee by Dec. 18.
Ms. McMaster is the vice president for Patient and Donor Affairs, Organ Procurement Transplant Network/United Network for Organ Sharing, Board of Directors. UNOS is based in Richmond, Va.
Look for additional information on KAS in Ms. McMaster's column in the December issue of NN&I.
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