Executive order will overhaul transplant, dialysis systems

LINDA DAVIDSON/WASHINGTON POSTSurgeons transplant a healthy kidney at Medstar Georgetown University Hospital in Washington, D.C., in 2015.

President Donald Trump will order a broad overhaul of the nation’s organ transplant and kidney dialysis systems today in an executive order designed to prolong lives and save the government billions of dollars, according to people familiar with the plan.

Trump will outline proposals to keep people with kidney disease off dialysis longer and make treatment less expensive; encourage more live donation of kidneys and livers; and force the 58 nonprofits that collect transplant organs to improve their performance, people briefed on the plan said. He also will try to reduce discards of less-than-perfect organs by transplant surgeons.

In all, the government believes it can make 17,000 more kidneys and 11,000 more hearts, livers, lungs and other organs available for transplant every year, as well as save money for Medicare and Medicaid, which cover much of the cost of dialysis and transplantation. The United States has a severe shortage of tranplant organs. More than 113,000 people are waiting for them; most need kidneys.

The executive order the president is expected to announce today, first reported by Politico, is one of a series of health care initiatives Trump is announcing in the runup to the 2020 presidential election.

Kidney dialysis is a grueling regimen endured by about 510,000 of the 726,000 people who suffer from end stage kidney disease, according to the National Kidney Foundation. In the United States, most people receive hemodialysis, a treatment that requires a device to filter waste and toxins from their blood in hours-long sessions three times a week. Most receive it in clinics or private facilities that serve dozens of people each day.

Average life expectancy for a person on dialysis is five to 10 years, though some live much longer.

In some other countries, however, most people receive peritoneal dialysis, a treatment that uses a fluid infused through a catheter implanted in the abdomen, often while the patient sleeps at home. The process is less expensive than hemodialysis but is used only by a small percentage of U.S. patients. With training, patients also can receive hemodialysis at home.

Now, the U.S. system creates incentives for clinic-based hemodialysis. Physicians generally are reimbursed at higher rates for care of dialysis patients than for treatment of patients with kidney disease who don’t yet need dialysis.

Medicare spent more than $89,000 per person, according to the kidney foundation. Transplant patients cost Medicare $35,000 per person.

Johnson Newspapers 7.1

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