Concerned about rising rates of discarded kidneys, the nation’s most influential renal health organization is undertaking an effort to put more organs to use and increase access to lifesaving transplants.
The National Kidney Foundation said it has convened a panel of experts who will develop recommendations for reforming practices that caused hospitals to throw away more than 3,100 donated donated kidneys in 2015.
“Every kidney potentially saves a life, so that number is quite distressing,” said Dr. Matthew Cooper, cochair of a national steering committee organized by the foundation to examine the problem. The group will develop best practices for evaluating donors and procuring organs, and consider whether a special system could be established for sending less-than-perfect kidneys to hospitals prepared to use them.
Its recommendations are expected to be released in the spring or summer of next year. This effort complements a proposal by the United Network for Organ Sharing (UNOS) to eliminate geographic inequities in the availability of donated livers.
STAT reported last week that hospitals are increasingly tossing out less-than-perfect organs — and rejecting the sickest patients — out of concern that poor surgical outcomes will lead to increased scrutiny from federal regulators. The problem is worsening shortages of all types of organs, including hearts and livers, but the impact on the availability of kidneys is particularly severe. The median wait time for a kidney is about 3.6 years.
Last year, 3,159 donated kidneys were discarded, up 20 percent from 2007, when the Centers for Medicare and Medicaid Services instituted performance standards that increased pressure on transplant centers to produce consistently positive outcomes.
In 2014, more than 4,700 people died while waiting for a kidney transplant, according to the National Kidney Foundation.
In recent months, CMS has begun to give transplant centers more leeway in meeting standards. In May, the agency issued a memo relaxing sanctions on centers that failed to meet its standards, which are based on numbers of failed transplants and one-year survival rates and calculated through yearly national averages and risk profiles specific to a hospital.
While its adjustments have helped, Cooper said, there still needs to be a set of best practices that physicians and transplant centers can rely on to prevent useable kidneys from being thrown out. Cooper said simple communication breakdowns are preventing donated organs from getting to transplant centers fast enough to be used. He also noted that physicians can allow misperceptions — and unfounded concerns about the suitability of organs — to affect their decision-making.
“In a lot of ways, it’s trying to change behavior,” Cooper said. “Physicians and surgeons get in a pattern of saying yes to this, and no to that.”
He added that the steering committee will be examining whether a new system should be devised for pairing less-than-perfect kidneys with transplant centers and patients willing to accept them. “Should there be programs that are designated as centers of excellence for donating these particular types of organs?” Cooper asked. “Can we find a way to minimize the time it take to allocate these organs so there is a better chance of using them?”
The National Kidney Foundation’s initiative is part of a broader effort to fix the nation’s transplantation system. On Monday, UNOS unveiled a proposal for improving distribution of donated livers. Its plan would reduce the number of regions from 11 to eight to help eliminate inequities that make it harder to get liver transplants in some parts of the country. Those imbalances cause many patients seeking transplants to travel across the country in search of a center that will connect them with a donated organ.
In many cases, because of concerns about meeting federal performance standards, those patients are told they are too sick to undergo surgery. Tom Nealon, chief executive of the American Liver Foundation, said the shortage of available organs is only getting worse.
“There are 17,000 people on [liver transplant] waiting lists right now and last year only about 6,000 transplants were performed,” he said. “That obviously indicates a major problem.”
This story was updated Wednesday with a clarification on the proposal by the United Network for Organ Sharing to improve distribution of donated livers.