From Health Line, by Kristen Fischer
By the time Quinn needs his help, however, Broadman said he may be dead or too old to donate a healthy organ.
“I approached UCLA and asked, ‘Why don’t I give a kidney to someone who needs it now, then get a voucher for my grandson to use when he needs a transplant in the future?’ And that’s just what we did,” Broadman said in a statement.
How the program works
Broadman worked with Dr. Jeffrey Veale, a transplant surgeon who helped initiate the program at the Ronald Reagan UCLA Medical Center.
The voucher program is relatively simple.
A person donates their kidney and selects a recipient for a future donation.
The recipient receives a voucher that can be used if they need a living kidney donation. Living kidney donations are made when a person who is alive donates one of their two kidneys and goes on living with the remaining one.
The program could change the face of kidney donation in the United States, bringing more donors to the operating table.
The American Society of Transplant Surgeons has endorsed the program, which is being used at nine other transplant programs across the United States under the umbrella of the National Kidney Registry (NKR).
Essentially, you donate when it is convenient and others receive if it’s necessary, Veale told Healthline.
There are 26 million people with chronic kidney disease in the United States. Some may progress to end-stage renal disease and would be ideal candidates for transplant, the National Kidney Foundation reports.
There also are 500,000 people in the U.S. with a functioning transplanted kidney. The new organ typically lasts 10 to 20 years.
Risks, logistics, and legalities
Ruthanne Leishman, who heads up the Kidney Paired Donation program for United Network for Organ Sharing (UNOS), said transplant surgery comes with pain and a risk of infection.
There is, however, only a low risk of death.
There is a waiting list for deceased donations but not for living donations, Leishman said. Her organization manages deceased donor allocation on behalf of the Health Resources and Services Administration, an arm of the Department of Health and Human Services.
Unlike donations from the deceased, which only go through UNOS, living donations go through a variety of organizations such as the NKR.
Veale told Healthline that a donor can add up to five people onto a voucher. Potential recipients must have kidney disease and the voucher can be used only by the first person who needs it.
For some families with genetic polycystic kidney disease, they usually know someone will need a transplant in the future, so being able to name multiple possible recipients can be helpful.
“Whoever would need the transplant first, the voucher would go to that person,” Veale said.
Vouchers are not transferable and they expire when the donor passes away. In that case, if the recipient does not use it, the donation becomes altruistic, meaning it would go to a stranger instead of a specified recipient.
Vouchers cannot be sold to another person and cannot be withdrawn.
To make sure the recipient is who they say they are, doctors complete human leukocyte antigen (HLA) typing and record the recipient’s blood type — a sort of blood fingerprinting system. [Read more]
Dialysis News
Home-based kidney dialysis remains a relative rarity, with only one in ten U.S. patients able to receive peritoneal dialysis and hemodialysis at home, according to national averages.
But driven by the staggering cost of outpatient dialysis treatments and improvements in home dialysis technology, one chain of dialysis clinics has been able to double that average. And it aims to double it again through an innovative program involving feedback from patients as well as nephrologists and payers.
The costs paid by Medicare tell the tale: While dialysis patients represent less than 1% of the Medicare population, they also represent 6% to 7% of the total cost of Medicare.
Satellite Healthcare, based in San Jose, CA achieved its doubling through its Wellbound Centers, which are dedicated to peritoneal dialysis and hemodialysis and include a training room or space to instruct patients how to perform home dialysis. It serves 7,000 patients in six states.
For two days in June, Satellite brought patients from its service area to San Jose, CA to brainstorm new technology and workflows in an effort to double its home dialysis rate again to 40%.
"There's absolutely a feeling in the nephrology community that we can bring the benefits of home therapies to a greater number of patients," says Graham Abra, MD, medical director at Wellbound San Jose. He is also a practicing nephrologist at Stanford Medicine and clinical assistant professor at Stanford Medical School.
Less Travel, Better Quality of Life
A major benefit of home dialysis is eliminating the travel time required for patients to get to and from dialysis clinics. "They have clinical benefits, in that these therapies in general often lower the number of blood pressure medications and phosphorous-binding medications that patients need to take," Abra says.
"In general, people's quality of life appears to be better on these therapies than on in-center therapies. They recover more quickly after the dialysis treatments that are performed at home. An average in-center patient might take 6 to 8 hours to feel normal after a dialysis treatment, and that could be as low as an hour or so for someone doing home treatment."
Just as Abra believes the dedicated training space at Satellite Wellbound centers has made a big difference in the amount, quality, and effectiveness of home dialysis training, he believes a recent brainstorming session could help dialysis patients at home to get past some of the dialysis workflow problems they face there.
"We heard a lot about the challenges of managing the supplies that are used in the home for peritoneal dialysis and home hemodialysis," Abra says.
Timely Communication
"We heard a lot about the challenges of setting up someone's house in order to do the dialysis at home. I think those are really important details that impact people's quality of life, and often aren't front-and-center in a nephrologist's mind necessarily, [or] even the clinic staff."
Abra points to the Apple iPhone's text messaging as an example of a technology which is currently underutilized to smooth issues and improve patient experience.
He says he was "really struck by the idea that many of our patients have struggles with communicating in a timely manner back and forth with the clinic, with keeping track of their treatment logs, with supply ordering, with alarms that frequently come up on [their home] machines for which they have to search through a big binder of stuff to figure out what they are."
Abra thought technology could be "very helpful."
"All these things kind of scream, 'gosh, put that in an app that can be easily accessed on a tablet or a smartphone, so that you can quickly communicate with your healthcare provider either by text or image.'"
"You can quickly look up common things that are happening with your dialysis machine and troubleshoot it, you can potentially send in your logs electronically so that you're not dealing with pencil and paper, and your healthcare team has timely access," he says.
"There's been huge impetus and focus on advancing the quality."
Satellite executives are in the midst of ranking the many ideas that came out of the workshop, and plan to roll out innovations at small scale in several Wellbound Centers before deploying them widely.
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