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Published on: October 11, 2014
An opt-out model for kidney transplant referral: The time has come
Anne M Huml1, John R Sedor1, Emilio Poggio1
1Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
Abstract:
Disparities that affect equity in access to kidney transplantation for patients with kidney failure have been well described. Many robust clinical trials have tested the effectiveness of interventions to reduce disparities and equilibrate access to kidney transplantation. Moreover, policy changes have been enacted to achieve the same aims. Despite these efforts, rates of kidney transplant waitlisting within the first year of end-stage kidney disease have remained unchanged over the past 2 decades, while incident rates of end-stage kidney disease have climbed. Because prior interventions have not durably increased transplant access, disruptive change is clearly needed. The Advancing American Kidney Health Executive Order sets bold goals to transform kidney care for patients and caregivers. In this spirit, we discuss an Opt-Out for Transplant Referral Model as a compelling solution to improve equity in access to kidney transplantation.
Insights
Kidney transplant access disparities persist despite interventions. An Opt-Out for Transplant Referral Model offers a disruptive solution to improve equity for kidney failure patients awaiting transplants.
Area of Science:
- Nephrology
- Transplantation
- Health Equity
Background:
- Significant disparities in kidney transplant access for patients with kidney failure are well-documented.
- Previous interventions and policy changes have failed to improve waitlisting rates over two decades.
- Rising end-stage kidney disease incidence exacerbates the need for effective solutions.
Purpose of the Study:
- To address the persistent inequities in kidney transplantation.
- To propose a novel model for improving access to kidney transplants.
- To align with the goals of the Advancing American Kidney Health Executive Order.
Main Methods:
- Review of existing literature on kidney transplant disparities and interventions.
- Analysis of trends in kidney transplant waitlisting and end-stage kidney disease incidence.
- Conceptualization and discussion of the Opt-Out for Transplant Referral Model.
Main Results:
- Despite extensive efforts, kidney transplant waitlisting rates have not improved in 20 years.
- End-stage kidney disease incidence continues to rise, widening the gap in access.
- The proposed Opt-Out for Transplant Referral Model presents a potentially disruptive approach.
Conclusions:
- Current strategies are insufficient to overcome kidney transplant access disparities.
- Disruptive innovation is necessary to achieve equitable kidney transplantation.
- The Opt-Out for Transplant Referral Model offers a promising pathway toward improved equity in kidney transplantation.
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