Letter to the editor: For more transplants, we need more kidneys

Georgia Health News recently reported on the wide variation in dialysis facility-level referrals for kidney transplantation, an issue of high concern among providers who care for patients with kidney disease. (Here’s a link to that article.)

Dr. Allen Nissenson
Dr. Allen Nissenson

Patients with end-stage renal disease need dialysis or a kidney transplant to live. Your report notes that the Southeast has the lowest kidney transplant rate in the country. It is important to understand what’s contributing to not only the low transplant rate but also the variation in dialysis facility-level referrals.

Rachel Patzer’s study sheds some important light on the issue, noting what contributes to variation in timely referral rates . . . and what does not.

As to be expected, socioeconomic status factors were noted as barriers to referral. There are real issues and barriers to obtaining a transplant, particularly in minority populations, and efforts should be intensified to educate these patients to help them navigate the transplant evaluation process.

This paper also demonstrated that the for-profit dialysis providers in the study tended to have higher rates of timely transplant referrals than nonprofit providers.

We were not surprised by this finding. Previous papers showing that for-profit dialysis facilities were behind in patient education when compared to nonprofit facilities were misleading.

These papers reflected education before the patient started outpatient dialysis. Patzer’s study examines the actual rates of timely referral from the dialysis facility to one of three transplant centers in Georgia.

DaVita Kidney Care has long been committed to ensuring that its patients receive a thorough kidney transplant education within 30 days of their first dialysis treatment. Patients are educated about the step-by-step transplant process and requirements, health benefits of a transplant and the transplant center options available to them. Our social workers also offer patients ongoing education about kidney transplantation at least once a year.

However, neither the study nor your article addressed the largest barrier for patients with end-stage renal disease: the number of donated kidneys available.

There are more than 100,000 candidates on the kidney transplant list, according to the United Network of Organ Sharing (UNOS), which provides real-time transplant statistics. Kidneys are the most sought-after donor organs, and since supply has not kept up with demand, the average wait time is three to five years.

For many patients, that is simply too long. We are proud of our dialysis center staff and the dedication they show to providing transplant education in a thorough and thoughtful way. But without an increase in the number of donor kidneys, fewer patients will have the opportunity for a successful transplant. We encourage further attention to the inadequate number of donor kidneys available to help change that reality, so more patients with kidney disease can have a healthy future.

Allen R. Nissenson, MD, FACP

Chief Medical Officer

DaVita HealthCare Partners