An executive order that President Donald Trump signed last week has the potential to cut kidney disease rates, make dialysis more convenient and increase the number of organs available for transplant.
That means an improved quality of life for some Americans and a second chance at life for others. The order also creates an opportunity to reduce racial, geographic and income-based health disparities.
Mr. Trump’s order requires the U.S. Department of Health and Human Services to develop a public awareness campaign aimed at reducing kidney disease, which the American Kidney Fund calls the nation’s ninth-biggest killer. Kidney disease affects an estimated 31 million U.S. adults. It’s closely associated with poverty and disproportionately affects people of color. It’s also more prevalent in some areas than others because of variations in diet, accessibility of health care and other factors.
Simple lifestyle choices can help people ward off kidney disease, and early detection is important for those who do get it. A public education campaign, national in scope and modeled after the ad blitzes responsible for increasing seat belt use and decreasing tobacco consumption, could have a huge impact.
Mr. Trump ordered the human services department to make proposals for supporting additional research into kidney disease, including the development of an artificial kidney, and he directed a possible restructuring of the Medicare payment system so that patients requiring dialysis can have it at home instead of in clinics. That has the potential to bring comfort and convenience to millions of Americans who now have to spend hours at dialysis clinics each week.
The executive order also requires the government to cover more costs associated with so-called living donor transplants — a step that could boost organ donation rates.
Healthy people only need one kidney to live, leaving one that can be donated to family, friends or even strangers if donor and recipient are deemed compatible. People may donate part of their liver, too, and rarely a uterus or segments of other organs. While the recipient’s insurance picks up the donor’s medical bills, Mr. Trump’s order would have the government cover lost wages, child care or other costs that prevent more people from becoming living donors.
Other parts of Mr. Trump’s order are concerning. He directed the department to develop metrics for better measuring the performance of organ procurement organizations — the 58 groups nationwide involved in recovering organs from deceased donors — and he ordered the department to develop a better kidney allocation process. The first is to be done in 90 days and the other in 180 days.
Both are unrealistic time frames for work Mr. Trump hasn’t even justified doing. The Center for Medicare and Medicaid Services and the United Network for Organ Sharing already ride herd on organ procurement organizations. UNOS also establishes — and periodically tweaks after exhaustive study — the rules for organ dissemination.
If these parties aren’t doing their jobs, Mr. Trump needs to provide the evidence. The last thing the transplant system needs is bureaucratic or political meddling, and any changes should include input from UNOS and all parts of the transplant community.
About 113,000 people are on U.S. transplant waiting lists, and there aren’t nearly enough organs for all of them. The government should adopt policies that cut chronic disease rates and maximize organ transplantation while relying on the excellent transplant system infrastructure already in place.
First Published: July 14, 2019, 11:00 a.m.
