Covering Anti-Rejection Drugs for Kidney Transplant Patients: What is being Done?

A young women was lucky enough to receive a kidney transplant only to have the kidney stop functioning after the government stopped paying for the anti-rejection meds 3 years after surgery, which is Medicare policy. Read Jeannette Castaneda heart breaking tale of of how her transplanted kidney stopped functioning after she could no longer afford her anti-rejection meds here. Basically, Medicare is willing to pay ~$100,000 for a transplant or ~$70,000 per year for dialysis but it won't pay ~$17,000 per year for anti-rejection drugs to keep the organ alive after 3 years. Once the organ fails and the person again is SUFFERING from ESRD, Medicare is happy to again pay for another transplant or diaysis. Make sense???!!!
After an organ transplant, patients need to take immunosuppressive (AKA ant-rejection) medicine for the rest of their lives to lower the probability of the body rejecting the transplanted organ. This leads to increased life expectancy for both the organ and the person.
Medicare covers dialysis or kidney transplantation for people with ESRD but stops covering the anti-rejection medicine 3 years after a person obtains a transplant.
Because of the expense of these drugs, people some time stop taking their medicine and the transplanted kidney stops functioning at an acceptable level and the person is again suffering from ESRD and needs another transplant or needs to go onto dialysis.
I wrote about this phenomenon in August 2010 here
I saw a thorough article about the subject titled Cost-effectiveness of extending Medicare coverage of immunosuppressive
medications to the life of a kidney transplant here.
There have been House and Senate bills
(see here and here for links to the proposed legislation) introduced to deal with this problem and make kidney transplant recipients eligible for anti-rejection medicine for life. This is the ethical thing to do because it increases life expectancy and improves quality of life of the kidney transplant recipient.
It also makes economic $en$e to pay ~$17,000 annually for anti-rejection medicine for the life of the patient because if the organ fails, then Medicare will again pay for ESRD treatment for the person - whether the $100K for a transplant (if you are lucky enough to get it before you die because of the long waiting list) or the ~$70K per year for dialysis.

What is wrong with our policy makers?
People are literally dying from their stupidity!!!

Progress: Bone Marrow Donors Can Now Be Paid For Certain Donations

A legal loophole currently exists which allows people to be paid for their donation of bone marrow when its made through a process similar to a blood donation. They will not be opening themselves up to prosecution which can lead to a fine and jail time.

See this opinion piece by Sally Satel, M.D. (who deserves a big kudos for valiantly challenging the political and medical community hegemony which outlaw people from exchanging valuable consideration, otherwise known as money, to obtain an organ transplant) here which was in the Wall Street Journal this morning for more details.

Obviously, if people want to make altruistic organ and tissue donations, they should be lauded for their sacrifice.

But many people die while awaiting a donation. So paying people to donate is an alternative which should be legal when coupled with certain legal protections. See my posts about the subject here and here Also, we pay physicians for their efforts to keep poeple alive, we pay companies for artificial heart pumps which keep people alive, and we pay for dialysis to keep people alive. Why shouldn't we allow people to pay for organs in a regulated environment to insure people are informed of all of the reasons both pro and con and them let them make their own informed decisions!!!???

The following is a paragraph excerpted from an earlier post realting to this subject:
There is currently a government policy forbidding “valuable consideration” which is legalese for money to be exchanged between parties in order for one party to supply a kidney to the other party who is suffering from ESRD. This policy was introduced as an attempt to squelch the market for trafficking of human organs. While the intentions might arguably have been noble at the time the legislation was passed, with the benefit of hindsight, the unintended consequence of this legislation leads to additional thousands of people dying annually who are on the U.S. kidney transplantation waiting registry but succumb to the vagaries of ESRD before a kidney become available for transplantation.

It is time to modernize and change the National Organ Transplant Act of 1984 (NOTA) so that one more person doesn't have to die needlessly because of this antiquated and obsolete law!!!

Transforming Healthcare: How to turn Data into Knowledge to Inform Decisions

One piece of data does not do much to help people make informed decisions to improve their health. One piece of data is a snapshot of a sliver of time which may or may not be an accurate reflection of the health of a person.

When many individual pieces of data are collected together over a time frame the information gleaned from that information (that is right - many data points come together to become information - not just data) is much more useful to appreciate the state of health of a given individual. A trend can be deduced so the person can understand if they are getting healthier, less healthy, or are pretty stable.

With the current state of technology, it is really close to willful neglect that so many people are constantly bombarded with individual data points about their health - but that data is not turned into (actionable) information.

Case and Point: Many people take their blood sugar daily or even many times a day to monitor their blood sugar. While this data is useful for immediate decisions to help people with diabetes manage their blood sugar, these data points are very frequently not appreciated by people in graphical form to help them understand how well they are managing their blood sugar. And even though there is an A1C test which tells a person the overall state of their blood sugar over the previous 3 months, that figure is often too macro/general a number to help the person understand which individual meal and snack choices directly cause their blood sugar to sky-rocket or stay in normal range.
If people could link (through time and date) their individual blood sugar numbers (data point) with their individual food consumption choices (data point), the information gleaned becomes useful information. Useful information (in the form of many data points) becomes the basis of knowledge. Knowledge helps people and their healthcare providers make informed decisions, or evidence based decisions, which can truly transform the state of people's health.

Looming Shortage of Physicians: Graduates of Foreign Medical Schools

In my previous post, I begin discussing the projected looming shortage of physicians. Here and here are 2 interesting articles that analyze the phenomenon.

The mechanism to fund residency slots need to be reformed to increase the supply of physicians in the U.S.

The U.S. could increase the supply of physicians by over 5,000 annually if it found residency slots for graduates of foreign medical schools who pass all of their examinations to be eligible for a U.S. residency slot but don't get a position because of the shortage of slots available. See the Educational Commission for Foreign Medical Graduates fact card which is linked to here which details the shortage of residency slots (over 5,000 annually compared to surplus supply of qualified physicians). In fact, for the past 3 years, only 42%-44% of these qualified physicians have successfully obtained residency positions.


There is one dirty secret about the impending physician shortage. The primary funding for residency slots come from Medicare and the number of residency slots funded have been capped at the 1996 level (~100,000 positions annually) based on the Balanced Budget Act of 1997. Therefore, even if our medical schools produced an infinite number of graduates, these graduates could not obtain a license to practice medicine until they finished their residencies, and they cannot do that due to the acute shortage of slots available.

There isn't a shortage of physicians, rather there is a shortage of political will among policy makers and politicians to fix this looming man-made disaster. If you show up do your doctor's office and there is nobody their to treat you - unless you are connected or willing to wait a while - like weeks or months - you will know who to blame.

Impending Physician Shortage: Lessons in Supply and Demand:

The above image was taken from here. All rights are served to the Association of American Medical Colleges (AKA the AAMC).

Lately, in conversations with physicians and corporate health plan executives, I have been hearing a lot about the expected shortage of physicians in general and of primary care physicians in particular. The Association of American Medical Colleges forecasts a shortage of 90,500 physicians by 2020. This is due to a confluence of factors including:

1. Many physicians retiring
2. Not enough physicians being graduated from American Medical Schools
3. An estimated 30,000,000 additional Americans who are going to have health insurance from Obamacare
4. The aging of America as baby boomers become senior citizens and require more healthcare services
5. Low reimbursement rates from Medicare and other payors for primary care physicians

Personally, I believe that we won't experience the acute shortage of physicians that many are forecasting. I believe with some minor policy changes, we can properly align incentives to promote an equilibrium quantity of physicians in general and primary care physicians in particular.

I will discuss this more fully in a later post but some ideas to think about:

1. Increase the quantity of Nurse Practitioners and Physicians Assistants
2. Create more residency slots so we can allow more newly minted physicians to place into residencies after completing their medical education. Also, this will allow more foreign medical school graduates to find residency positions which will also increase the quantity of physicians available
3. Mandate more residency slots be offered in areas where shortages exist like the primary care field and less in specialties which offer high reimbursements but no shortages of docs
4. Technological innovations like primary care physician software that automatically orders specific tests and tracks certain metrics (like weight, blood pressure, glucose, etc) to help physicians monitor health without as many office visits
5. Increased use of email, teleconferences, and videoconferences for physician-patient contacts to answer minor questions when a full appointment is not really needed

To be continued....

Update: Steve Jobs Resigns: Reposting an Old Post Titled: Steve Jobs' Health, Apple Computer, and Organ Transplantation Possibilities

Steve Jobs has just resigned as CEO of Apple Computer. I wish him a speedy and complete recovery from his illness. Below, I am reposting an article I wrote from earlier this year where I suggested a way to increase organs available for transplantation - by encouraging coworkers (in addition to family, friends, and people who worship together at their given Congregations) to donate organs to their fellow coworkers. Are their any Corporate Health Promotion/Wellness Managers who aren't afraid to make waves who would like to champion this idea in their companies? If they look at their costs for paying claims for employees with ESRD/kidney failure who are on dialysis, they certainly should be paying attention.
The original post from Monday, January 24, 2011, is found below:

You probably have heard about Steve Jobs, CEO of Apple, taking a medical leave of absence so that he can focus on his health. Here is the press release. Previously, he has battled pancreatic cancer and undergone a liver transplant.

I wish Steve Jobs all the best and a quick and complete recovery and respect his right to privacy.

I hope Apple champions an intra-company live donor organ donation program whether Steve Jobs is currently in need of a transplant or not because this can bring a revolution to the world or organ transplantation. Corporations like Apple pay towards their employees health insurance costs so they have an economic incentive to keep their employees as healthy as possible. Also, the good-will created by saving and improving the quality of life of their employees is priceless. And it may just contribute towards saving the life of their CEO, Steve Jobs.

I think that an astute Medical Coordinator or Benefits Manager at Apple may want to seize on the opportunity created by the Steve Jobs health situation and implement a corporate initiative to encourage live donor donations from healthy Apple employees to other Apple employees in need of transplants (FYI - therefore, this would work for kidney donations, bone marrow donations, and partial liver donations, depending on transplant center policy.)
Three previous blog posts linked to here, here, and here discuss various statutory laws that decrease the ability to increase the quantity of organs available for transplantion along with a few of my ideas to improve the situation including intra-company live donor donation programs.

A Poorly Designed Government Progam: Medicare (non)Coverage to Create an AV Fistula for Hemodialysis Access: A Case Study

While the U.S. government should be commended for offering universal health coverage for people with ESRD who require dialysis due to kidney failure, the Medicare program could be designed in a more efficient manner to promote increased life expectancy while saving the government money as well (in other words, have cake and eat it too.)

I want to deal with just one point to bring out this point. People who undergo hemodialysis who have vascular access points with AV Fisutulas have lower mortality rate compared to people with catheters. They also have decreased costs related to their treatment. (For examples of articles that support these suppositions, see here and here.

Moreover, Medicare's ESRD coverage does not cover the surgical procedure to create an AV Fistula before dialysis begins even though this correlates with lowered mortality decreased costs. See here for Medicares description of benefits for people with ESRD. The pertinent passage is excerpted here: "Important: Medicare won’t cover surgery or other services needed to prepare for dialysis (such as surgery for a blood access [fistula]) before Medicare coverage begins. However, if you complete home dialysis training, your Medicare coverage will start the month you begin regular dialysis, and these services could be covered." (See pp. 11-12 of the link provided above for a fuller explanation.)

Here is the bottom line. Medicare for people with ESRD should cover the costs associated with creating AV Fistulas for all people who require dialysis because this correlates with super clinical outcomes for the people undergoing dialysis (which leads to a lower mortality rate) while also resulting in substantially lower costs compared to people with catheter access.

Ethical Dilemnas in Directed Kidney Donations

Should a person be able to donate his or her kidney to whomever they prefer, or should all kidneys go to the next person on the waiting list?

This is a major ethical dilemma. Basically, with one possible caveat, I feel that a person should be able to direct their kidney donation to whomever they see fit. I explain my opinion fully below.

Basically, Douglas Hanto, M.D., a Harvard Medical School physician, is quoted to have said “Organs should go to the person who needs them the most, not to people because they are members of a club.” See Dr. Sally Satel's article about one example of Dr. Hanto's action to try to stop directed kidney donation
here.

Robert F. Hickey, Ph.D. is a big advocate of live donor kidney donation. Dr. Hickey's life was saved by a live donor donation and he zealously advocates for the right of people to direct their live donor organ donation. He debated Dr. Hanto on this topic recently at Harvard University.

Robert F. Hickey asked me about my reaction to a situation that was raised at the debate at Harvard. A certain Rabbi who was in attendance said that he advocates for his congregants to donate their organs [exclusively] to other Jews and (I think) to only accept organs from other Jews. Below is my response to the Rabbi's approach.

"This is what I feel about a Jew, or any other segment of the population directing their donation to their own group. While I feel that their motives may not be completely pure, I care about pragmatic results, not some theoretical morality or utopian concept of altruism. If a Rabbi encourages his congregants to donate organs only to other Jews, I feel he is doing a morally just thing anyways b/c Jews are on the waiting list like everyone else so if he encourages his congregants to give directed donations and thereby increasing the pool of organs available for transplantation, there will be a net gain in organs available for transplantation and therefore it will, in final analysis, help Jew and non-Jew alike by that Rabbi encouraging his congregants to donate their organs to Jews."
"Now, a morally troubled outgrowth from such an approach that may arise would be if there was a non-Jew on the waiting list who would certainly die today without the transplant and a Jew who can still live for a while as he awaits a transplant. I would recommend in that situation to give the organ to the non-Jew (pay the organ forward) and then give the next organ that becomes available on the waiting list to the Jewish person on the waiting list."
"Besides for these reasons, I believe that the Rabbi can legitimize his approach from a personal autonomy/libertarian perspective as well."
"Personally, though, I feel the best thing to do would be to take a different approach. I think that the Rabbi may be misguided because his approach can be interpreted with a xenophobic connotation so I think he would be better off to teach his congregants the economics lesson I shared above so that his congregants will understand that by donating organ, they will help everyone on the waiting list, which will definitionally move all of the Jews on the list closer to getting their transplants as well."

I do think, however, that people will tend to donate organs in greater numbers for people they fell a greater kinship for (like family, friends, coworkers, etc.) so from a behavioral economics perspective, there would probably be an increased number of organs available for transplantation if we encouraged more people to give directed organ donations to people they are close with socially. This would, in final analysis, cause more lives to be saved so I think the Rabbi is doing a positive thing - saving human life.

Implanted Windpipe: Exciting New Technology in the Field of Transplantation!

Check out this Wall Street Journal article linked to here titled, "Lab-Made Trachea Saves Man," which discusses how Swedish physicians transplanted an artificial windpipe lined with the man's own stemcells into a man who was close to death because of a large tumor and now is doing well after receiving the transplant just a few weeks ago on June, 9th. There is no sign of rejection.

This is very important to the field of transplantation in general because this is the first time a windpipe has been successfully transplanted without it coming from a cadaver, or a deceased person. Therefore, this renews hope for other artificial tissues and organs to be successfully transplanted into the human body, and thus, hopefully saving many lives.

Also, this leads me to muse about possible (but unknown practical applicability)of covering donated organs and tissues with the patients own stem cells to lower the chance of the body rejecting the donated organ or tissue. This issue is briefly discussed in a Bloomberg article linked to here about this first artificially made windpipe successfully implanted into a human.

This is an exciting new frontier in the field of transplantation. In fact, we might call this the field of implantation because organs are only being implanted, not transplanted because the windpipe was not taken from a human donor.

ESRD Disease Management: Is it Posssible?

The Centers for Medicare and Medicaid Services approved 3 demonstrations projects to study health outcomes along with and economic costs of health management for ESRD patients who were enrolled in these projects (the intervention cohort) compared to populations that were not enrolled in the demo projects (the other cohort). The Evaluation report for the first 3 years of the 5 years demonstration projects in its entirety is found here.
The results were mixed - both in terms of health outcomes and cost savings.

The question is does disease management not work for ESRD populations or was there something wrong with the demo intervention designs (study design error) which caused these results?

I hope and believe that ESRD health management interventions can be designed to improve health outcomes for patients and also be (at least) budget neutral.

Practices from a country such as Italy which has much better ESRD health outcomes (See an older post here where this is discussed) should be used here in the U.S. to improves our ESRD health outcomes.

Also, we can study physicians and medical centers in the U.S. who have better than expected health outcomes with their ESRD populations and transfer their practices and protocols to the rest of the healthcare professionals who treat ESRD populations so that a ESRD health management intervention can designed which imoroves both the life expectancy and quality of life of the ESRD population in the U.S.

Lecture Delivered to College Statistics Class on ESRD: Rational Decision Making Model

This is a handout I gave out to an under-grad stats class (where I was a guest lecturer) where I attempted to use a real life situation to impress upon the students the importance of statistics. I then went through six published journal articles relating to this topic to show them how to make a rational decision based on the current literature and statistics available on ESRD to show them how to come to an "evidence based" decision.

Statistics: So What?
Case Study for Kidney Failure Treatment Options Using Statistics as a Guide
Presenter: Eli Lazovsky, MPH
Date: June 14, 2011–06–14
For: HTC Statistics Class
You are advising a friend who has ESRD/Kidney Failure about his/her treatment options. What would you suggest to them as a rational course of action. Remember, there is not necessarily only 1 correct option. Be able to back up (using statistics) whatever you decide to advise your friend. Your friend isn’t so proficient in statistics so (s)he is relying on what you learned in your statistics class to help out.
What is your recommendation to your friend. Focus on what decision correlates with the following goal: Increase Life Expectancy

Diagnosis: ESRD
Treatment Options:
A. do nothing
B. dialysis
C. transplant

B. Dialysis
1. hemodialysis
2. peritoneal dialysis
Type of Access Point for the hemodialysis
1. AVF
2. AGF
3. Catheter
Frequency of Hemodialysis
1. 3 times a week
2. 6 times a week
C. Transplant
1. Before starting dialysis
2. After starting dialysis
Status of Organ Donor
1. Deceased Donor/Cadaver Organ
2. Live Donor
Type of Organ
1. Ideal Organ
2. Marginal Organ

Treatment Modalities for ESRD Patients: How to Increase Life Expectancy

A person who has kidney failure, or ESRD, should be cognizant that the choices s(he) and their physician make regarding their care will effect their life expectancy.

For example, a study comparing Dialysis treatment in Italy and the U.S. points out that in 2006, the annual mortality rate for people with ESRD in Italy was 11.2+/-.6 compared to 24% in the U.S. A link to the abstract of the article can be found here.
The authors write, in part, that "[t]he following may explain the low mortality for ESRD patients in Italy: low prevalence of diabetes, high use of AV fistulae, delivery of care by nephrologists beginning in pre-ESRD stages, their involvement in placement of dialysis vascular access, and their physical presence requirement during dialysis sessions."

Keep in mind, as of 2006, only 38.6% of dialysis patients had AV fistulas compared to approximately 82% of dialysis patients in Italy (figures taken from the study cited above). Recent data is much more encouraging. As of December 2010, in the U.S., 57.5% of hemodialysis patients had AV Fistulas. See here.

AV fistulas are associated with lower infection rates compare to people with AV grafts and thus better long term outcomes for the patient.

A Veterans Administration study linked to here also found that people on hemodialysis who had AV fistulas lived on average about 3 months longer compared to people with AV grafts.

The bottom line is by studying the various manners of treatment for ESRD both domestically and internationally, ESRD best-practices guidelines can be fashioned to increase the life expectancy and the quality of life for people on dialysis.

Why Doesn't the Kidney Transplant Waiting List Reflect the Missing 500,000?

This is a follow-up to the last post found here.
I think there are several possible components which together combine to give at least a partial explanation as to where are the missing 500,000 people with ESRD who are not on the kidney-transplant-waiting-list.
I think that a critical but correctable component of the problem is that the supply of kidneys that become available annually are so miniscule compared to the demand for kidneys, that patients and their physicians often face the grim reality that (under the current manner in which UNOS appropriates organs) their chances of obtaining a kidney are so slight that they make the sad (but often economically rational decision) not to undergo the financial, physical, and emotional burden and trauma of living with the constant anxiety of waiting for an organ that may never come so they just fore-go the process altogether and survive on maintenance dialysis.
This problem can be at least partially ameliorated by expanding the supply of kidneys available for transplantation - like by increasing the supply of live donors! (Another more long term approach to the problem is to screen high risk populations for high blood pressure [like African Americans, people with diabetes, etv.] before they present with symptoms of ESRD so that their blood pressures can be controlled and their kidneys continue to function at an acceptable level. This would decrease the amount of kidneys demanded on the transplant list.)
Some other components that may explain the missing 500,000 people from the kidney transplant waiting list may include:
1. Some people are so sick they would probably never live through the procedure so they don't bother trying to get on the waiting list.
2. Geographically, some people are very distant from a transplant center so they might not be able to get to the transplant center in time to get the organ so they don't bother signing up (but keep in mind that the time sensitive component of transplantation goes away with live-donor-donations).
3. Some people cannot afford the costs involved in the transplant. For instance, they might be denied a spot on the transplant list if the transplant center thinks they may not be able to afford the anti-rejection medication needed to elongate the lifespan of the organ.

The Missing 500,000 People: How Many People Could Benefit from Kidney Transplants?

Does any one know how many people can actually benefit from a kidney transplant in the U.S.? I'm sorry to say, the answer is no! There is an exact number of people registered on the waiting list, but if you are not registered on the list (if for example, you cannot find a transplant center willing to accept you) you are not counted even though you may desperately need a transplant to elongate your life!
Often, a problem cannot be dealt with appropriately until the problem is identified and the scope of the problem understood. There is a severe shortage of organs available for transplantation in general. I will only deal with the acute shortage of kidneys for the time being.
According to the OPTN, or Organ Procurement and Transplantation Network (which is affiliated with the the DHHS, or the Department of Health and Human Service's HRSA, or Health Resources and Services Administration) there are only 88,392 individuals awaiting a kidney transplant on their waiting list. (Accessed from http://optn.transplant.hrsa.gov/latestData/rptData.asp
based on OPTN data as of April 29, 2011)

According to the USRDS, or the United States Renal Data System, as of 6/30/2010 there were 591,642 people in the U.S. with ESRD. See here

That means there are over 500,000 people with ESRD who are not on the kidney transplant waiting list!!! Most of these people are on dialysis to keep them alive.
People who receive transplants live substantially longer than those on dialysis.
See here for more specific data on the subject.

So why doesn't the kidney transplant waiting list more accurately reflect the number of people who could benefit from transplants?
I'll try to partially answer that in another post.

Follow Up: Arizona Restores Medicaid Coverage for Transplants

Reuters is reporting here that Arizona has restored funds to its state Medicaid program so that it will once again cover organ transplantation once again. See one of my previous posts here where I vociferously attacked the cuts and the humanity of all involved in letting a lady die as a result of the cuts.

Its good to see that the people of Arizona (as reflected by the action taken by their elected representatives) have taken appropriate action to rectify an unconscionable piece of legislation which was resulting in the deaths of citizens of Arizona.

Again, this was not only a government-made disaster, but it was also a man-made disaster on many levels including the family, community, and medical field levels.

I dare to hope that there were some hospitals which performed transplants as charity care during the time when there was no Medicaid coverage. But I'd love to actually see some proof of that.

NYTimes Explores Dialysis: At What Cost Do We Keep People Alive

See this interesting (though slanted) article about dialysis, governmental policies which cover the cost of ESRD, and end stage renal disease (which includes dialysis treatment), and the NYTimes's slant that people who are very sick and very expensive to treat may be better off dying than going on dialysis (remind anyone of death panels?).

The NYTimes does do thoughtful readers and listeners a service by allowing dialysis patients to describe their lives in their own words. Listen here.

The bottom line is this - irregardless of what the NYTimes thinks. People living with ESRD, their doctors, and the stakeholders who pay for the treatment (like Medicare, insurance companies, and Corporate Self-Insurance health plans) should insist on the highest quality evidenced based standard of care for ESRD treatment which includes dialysis treatment. If this standard of care is applied, people with ESRD can live longer and costs can be contained.

Confronting the Intrenched Organ Donation System: It is possible

Below are examples of some blogs, websites, and articles which all confront the reality of the current (possibly semi-dysfunctional) organ transplant disbursement system and attempt to shine light on it, study it, and offer ways to improve it. Or, they break with the current system altogether and blaze alternative paths to increase the supply of organs available for transplantation.
I don't attest to the veracity of the claims made in these links. Make your own judgment. But the current system can most assuredly be improved. It will take people and organizations similar to those linked to below who aspire to improve the current system to create the change necessary which will lay the foundation to increase the supply of organs and thereby save lives.

For a live kidney donor recipient's personal outlook on the entrenched interests opposing live-donor donation see this website.

For a blog about alternative methods to increase the supply of organs available for transplantation see here.

For a website that attempts to link live organ donors with people in need of a transplant see this website.

For a press release about a grant awarded to study the outdated organ disbursement method and how it causes unequal access to donated organs based on where a person live see here . Also see here for an old post on the issue where I propose a study designed partly to determine the effect of a person's distance to a transplant center and the time it takes for the person to receive an organ. Yes, its a very technically worded post so don't say I didn't warn you.

And finally, see this link for a book titled, "The U.S.Organ Procurement System" where the authors, David L. Kaserman and A.H. Barnett engage in a thorough economic analysis of current U.S. organ transplant policy, the problems with it, and a proposal explaining how organ markets would operate in a manner which would save lives by increasing the supply of organs available.

Jonas Salk created the Polio Vaccine...Lessons for Kidney Transplantation

"Hope lies in dreams, in imagination and in the courage of those who dare to make dreams into reality."
The preceding statement comes from a memorial at the Salk Institute which captures
Dr. Salk's vision.
Dr. Jonas Salk prevented millions and millions of deaths when he created and engineered the polio vaccine in the 1950's. I am keenly aware of the human suffering he prevented...my grandmother grieved the rest of her life for her 17 year old son, Martin, who died of polio in September, 1954 - while Salk's new vaccine was being tested on one million school children.
Presently, in California, there is the Salk Institute which carries on the legacy of Dr. Salk which researches various phenomenon ranging from cancer, diabetes and birth defects to Alzheimer's disease, Parkinson's disease, AIDS and plant biology. See the Salk Institute's description here.

I was thinking about the quote..."Hope lies in dreams, in imagination and in the courage of those who dare to make dreams into reality."
Until their are enough courageous people willing to attempt to find a solution to the current shortage of kidneys available for transplantation, the hope to solve the problem is like a fleeting and illusory dream - and not a very hopeful dream on the cusp of being turned into reality.

Steve Jobs' Health, Apple Computer, and Organ Transplantation Possibilities

You probably have heard about Steve Jobs, CEO of Apple, taking a medical leave of absence so that he can focus on his health. Here is the press release. Previously, he has battled pancreatic cancer and undergone a liver transplant.

Original post from Monday, January 24, 2011 is found below:

I wish Steve Jobs all the best and a quick and complete recovery and respect his right to privacy.

I hope Apple champions an intra-company live donor organ donation program whether Steve Jobs is currently in need of a transplant or not because this can bring a revolution to the world or organ transplantation. Corporations like Apple pay towards their employees health insurance costs so they have an economic incentive to keep their employees as healthy as possible. Also, the good-will created by saving and improving the quality of life of their employees is priceless. And it may just contribute towards saving the life of their CEO, Steve Jobs.

I think that an astute Medical Coordinator or Benifits Manager at Apple may want to sieze on the oppurtunity created by the Steve Jobs health situation and implement a corporate initiative to encourage live donor donations from healthy Apple employees to other Apple employees in need of transplants (FYI - therefore, this would work for kidney donations, bone marrow donations, and partial liver donations, depending on transplant center policy.)
Three previous blog posts linked to here, here, and here discuss various statutory laws that decrease the ability to increase the quantity of organs availible for transplantion along with a few of my ideas to improve the situtation including intra-company live donor donation programs.

Do You Really Want Government In Charge of Healthcare?

An article by the AP linked to here regarding Arizona reducing its Medicaid coverage and the probable death of a second person as a result of it is mind-boggling and anger inducing for many reasons.
The travesty of this extends to the hospital system in Arizona - do they not have charity care? And what are the procedures at the organ distribution organization in Arizona - do they deny organs to people without insurance because of insurance status because they are worried about organ rejection if the patient cannot afford the expensive anti-rejection medicine?
And if what I surmised above is correct, what about the docs/hospital execs that have connections to pharmaceutical companies through reps - could no deal be quickly put together to have one of the pharmaceutical companies provide charity medication to this person?
And no family, good Samaritans, or friends to pitch in?
This makes me sick!

I'm in a hurry so I have to continue later, but I sense that the government through the Medicaid program is creating economic phenomenon of crowding out the market for charity medical care not only in Arizona, but throughout the country.
Hospitals, doctors, pharmacies, etc. are used to at least being able to collect some level of reimbursement from Medicaid so why bother to give anyone free care - even if the patient will end up dead as a result of this inaction!

First Successful Organ (Kidney) Transplant Donor Dies 56 Years Later; Brother Survived for 8 Years

The following press release was taken in its entirety from a box that popped up when I went on the American Society of Nephrology's website today. Basically, a brother donated his kidney to his brother and the brother who received the kidney lived for 8 more years, an unbelievable success for the world's first recorded successful organ transplant. This reminds us that the courageous people who challenge the status quo and don't accept so-called medical realities and, as a result, improve medicine and human progress for all mankind.
Although, I have a feeling Mr. Ronald Lee Herrick might have said he was just doing what any other brother would do to keep alive his sibling or family member - just about anything he could do.
Death of Mr. Ronald Lee Herrick, Pioneer Transplant Donor

Ronald Lee Herrick died Monday, December 27, 2010, at age 79, in Augusta, Maine.

Mr. Herrick, a math teacher for almost four decades, donated his kidney to his twin brother, Richard, on December 23, 1954, in what is recognized as the world's first successful organ transplant. Ronald's courageous act helped change the face of medicine by advancing development of the field of organ transplantation. This revolutionary surgery took place 56 years ago at what is now the Brigham and Women's Hospital and was performed by Dr. Joseph E. Murray. Dr. John Merrill, one of the founders of the discipline of Nephrology and chief of the Renal Division at the Brigham, was a member of the team caring for transplant recipients including Mr. Herrick.

Receiving a kidney from his brother allowed Richard to live an additional eight years. The American Society of Nephrology gratefully acknowledges Mr. Herrick's major contribution to medicine.

Joseph V. Bonventre, MD, PhD, FASN
President, American Society of Nephrology