President Trump made headlines Wednesday, but not for the usual reasons: The executive order he signed this time around has to do with kidneys. Specifically, it aims to improve care for patients with kidney disease by making home treatment more available and encouraging more kidney donations, Politico reports. It also aims to prioritize the development of an artificial kidney and help kidney patients get better treatment earlier, per the AP. At Vox, Dylan Matthews writes that this is "one of the biggest government actions on kidneys in decades" and that it "could save thousands of lives." He notes that 43,000 people die per year in the US due to a shortage of kidneys available for transplant; that's 3,000 more than the number of people killed each year in car accidents. He lays out Trump's three-part plan, which also touches on other types of organ donation:
- Living kidney donors, as well as liver, lung, and intestine donors, will be held financially harmless for donating. Currently, donors are typically required to cover costs like travel, childcare, lost wages, and other non-medical expenses. The executive order would, among other things, enable some of the significant costs to be reimbursed, which could lead to an increase in living donors.
- Deceased donations could also be increased, as the executive order will get rid of the current evaluation system for organ procurement organizations (OPOs), the 58 agencies that handle organ donations from deceased people. Critics and analysts have argued that OPOs underuse deceased donor organs, with reports ranging from as many as 28,000 to 75,000 usable organs abandoned, because the current evaluation system offers incentives for OPOs based on vague standards that make it easy for OPOs to game the system. The new system would look solely at two objective standards, making it possible "to ensure that OPOs are honoring organ donor wishes," according to one expert.
- Provider care for kidney patients would also be improved. In the dialysis industry, just two providers account for 83% of the market, and the lack of competition isn't great for patients. Neither is the fact that the centers are paid per treatment, which is a deterrent to home-based dialysis as well as preparing patients for a kidney transplant. "This is an untenable system," writes Matthews, noting that the three-times-a-week, four-hours-at-a-time typical dialysis schedule makes it difficult to hold down a job or travel. The executive order pursues a series of reforms in an attempt to give kidney patients alternatives to center-based dialysis.
"There hasn’t been presidential action [on kidneys] in 46 years," a senior administration official involved in the executive order says. "It’s time to take a comprehensive approach." See Matthews' full piece here
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