Regional Discussion: Living
Donation
National Trends

Deceased donors recovered increased by 9.8%, and
deceased donor organs transplanted increased by
10.7% from 2015

increases in ECD, DCD, SCD donors

DCD donors now comprise 17% of deceased donors
overall (ranges from 10%-25% by region)

0.4% decrease in living donation from 2015-2016.
Benefits of Living Donor Kidney Transplantation
 Shorter waiting time (usually 1-2 months); permits preemptive transplantation to avoid dialysis
 Higher quality kidney (healthy donor, short ischemia time), which results in higher success rates
and improved graft longevity
 Scheduled event, can plan accordingly, can be performed during normal work day by rested team
and fully prepared donor and recipient
 Psychological benefits to donor and recipient
 A living donor kidney transplant allows the deceased donor kidney that would be needed for this
recipient to be given to another individual in need of a transplant, so in essence two people are
removed from the kidney waiting list
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Expected remaining lifetime for recipients of a kidney transplant compared
with patients on dialysis (across sexes and various races)a
Recipients of a Kidney Transplant Have a Longer Life Expectancy Than Patients Who Remain on Dialysis
Based on estimates from 2012, recipients of a kidney transplant
had about 2.5 times more remaining years of life than patients on dialysis
a
Data are from the United States Renal Data System (USRDS) 2014 Annual Data Report; estimates are from 2012.
USRDS. 2014 ADR chapters. http://www.usrds.org/2014/view/default.aspx. Accessed February 11, 2016.
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Death rate of patients on dialysis at 5 years compared with patients with selected solid tumor cancers (all stages)1,2,a
Patients With Certain Cancers Have a Better Chance of Surviving 5 Years After Diagnosis Than Patients Starting on Dialysis
a
Dialysis mortality data are taken from the USRDS 2014 Annual Data Report; cancer mortality data are from the American Cancer Society (ACS) Cancer Facts & Figures 2015.
1. USRDS. 2014 ADR chapters. http://www.usrds.org/2014/view/default.aspx. Accessed February 11, 2016. 2. ACS. Cancer facts & figures 2015.
http://www.cancer.org/acs/groups/content/@editorial/documents/document/acspc-044552.pdf.
Accessed March 1, 2016.
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A Kidney Transplant From a Living Donor Results in Better Long-term
Outcomes Than a Transplant From a Deceased Donor or Dialysis
Patient survival rates
Donor kidney survival rates
a Data
are from the USRDS 2014 Annual Data Report; 1-year data are from 2011, 5-year data are from 2007, and 10-year data
are from 2002.
USRDS. 2014 ADR chapters. http://www.usrds.org/2014/view/default.aspx. Accessed February 11, 2016.
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Waiting List Additions
2007-2016
U.S.
Waiting List Registrations
2007-2016
Region 9
Deceased and Living Donors
2007-2016
U.S.
Deceased and Living Donors
2007-2016
Region 9
Deceased and Living Donors
2007-2016
U.S.
Region 9 does well in LD volume
Kidney Transplants
2007-2016
Region 9
Even in a high performing region their
are programs that perform higher % LDs
Deceased and Living Donor Transplants
2007-2016
Region 9
Region 9 Living Donors, 2014-2016
2014:552
2015: 542
2016:543
LD kidney: 516
LD kidney: 488
LD kidney: 500
LD liver: 36
LD liver: 54
LD liver: 43
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What can we do as a Region to Maximize LD Potential?
• Education
• Efficiency
• Removal of Disincentives
• Collaborative Efforts
LaPointe Rudow D, et al. Consensus conference on best practices in live kidney donation: recommendations to
.
optimize education, access, and care. American Journal Transplantation. 2015 Apr; 5(4): 5(4):914-22
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Education
• Public Education in needed
• Must also focus on candidate/ family and potential donors
• Various programs available, House Calls, Donor Champion, Kidney
Coaches
• UNOS Kidney Transplant Learning Center to be launched late 2017
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How Do We Help Patients Find a Living Donor?
In January, the National Kidney Foundation (NKF) launched The Big Ask: The Big
Give:
• A free, educational campaign that teaches kidney patients how to ask their
friends and loved ones to consider living organ donation. It also includes
extensive information for those considering donation.
• Includes a website at www.kidney.org/livingdonation, downloadable
publications, peer support, and the NKF Cares Help Line.
• NKF is also developing ½ day workshops for patients, families, potential donors.
o Interactive training workshops on “how to ask” and find potential living donors
o Workshops are being pilot tested now through Mt. Sinai, Montefiore and Hackensack.
o Mt. Sinai partnered closely with NKF to develop the curriculum and training materials.
• For more information, contact Jennifer Martin at NKF: [email protected]
Efficiency
Individual center commitment of staffing and resources to live donation
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Financial Assistance
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Qualifying Expenses:
Travel, lodging, meals & incidental
expenses
•Exclude Merchant
Codes Not Related
to Travel
•Add funding as
needed, generally
one week before
travel
 3 trips for the donor
 2 trips for the support person
 Up to $6,000
 Up to 2 years after donor surgery
 Transportation, lodging, and subsistence expenses
 Federal per diem rate for meals (transplant center city)
 Hotel up to150% federal per diem rate
% U.S. Living Donors With NLDAC Support
Calendar Year-OPTN Data 1/23/17-NLDAC Data 1/23/17
Donor Travel: Annual Expense
NLDAC Database August 31, 2016
FY September 1 – August 31
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Laura and John Arnold Foundation
Randomized Controlled Trial to Evaluate the Effect of
Lost Wage Reimbursement to Potential Kidney Donors
on Living Donation Rates (The Donor Lost Wages
Study)
• Grant awarded to the American Society of Transplant Surgeons in
partnership with Arbor Research Collaborative for Health with additional
researchers from University of Arizona, The Wharton School of the
University of Pennsylvania and the Mayo Clinic of Arizona
• Began in 2017 and is projected to run through 2018
• Five Transplant Centers will participate in the trial
• Transplant recipients will be randomly offered or not offered wage
reimbursement for their donors
Payers toUnited
Cover
for Donors’
LDs
Health care Travel
Will Reimburse Kidney
Travel
Expenses, Expanding Life-Saving Access to Kidney
Transplants
BOSTON (June 13, 2016) – United Health care will pay
travel expenses for kidney transplant donors, addressing
one of the major barriers to living organ donation.
The announcement was made yesterday at the
2016 American Transplant Congress in Boston by Jon
Friedman, M.D., chief medical officer for Optum’s
Complex Medical Conditions programs. Optum is the
health services company that manages transplant
services for United Health care. Both companies are
collaborating with the American Society of Transplantation
(AST) and American Society of Transplant Surgeons
(ASTS), which hosted the congress, to improve outcomes,
reduce costs and enhance the experience of donors and
recipients.
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LD Financial Assistance
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Steps to Increase Access to Live Donation in NYS
Living Donor Work Group
• New York State Live Donor Support Act ( A5475/S2498)
• Reimburse lost wages travel and other expenses to live donors
• The program will pay LD expenses for LDs who are NYS residents donating directly or
through KPD to a NYS resident recipient
• The amount reimbursed may be limited to an annual salary of 125,000 or 14,0000 for a
single donor.
• Time off will be approves for 4 weeks and 8 with exceptions
• Creates education materials for dialysis providers and nephrologists to
distribute to their transplant-eligible patients
• Insurance clause for Medicaid insured donors.
• Bipartisan Approval: 44 sponsors in the Assembly and 22 members in the
Senate
• Bill has been included in Senate Budget
• Need strong push to get the Assembly and Governor to agree to it in the budget
negotiations (which should conclude April 1st).
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Groups Endorsing Model Legislation
Discussion
• Much collaborative activity has occurred around live donation in
Region 9
• Is it time for an NYCKT?
• Financial resources
• Designated Staff
• Collaboration on Education and Advocacy LD initiatives
• Next steps?
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