Healthcare / Regulation

Regulations and Organ Donations: An Unhealthy Recipe

The waste and inefficiencies that plague healthcare in the United States are well known and well documented, but recently the New York Times published an astonishing article that reveals the extent of the problem. The article reports that nearly 18 percent of kidneys that could potentially be used in life-saving transplants are discarded each year due to an inefficient and over regulated system. Last year 4,720 people died while waiting for transplants and more than 2,600 kidneys were discarded.

As the article explains, a large part of the problem is government oversight of transplant success rates. For transplant centers that experience failures over 50 percent, the programs are flagged. If failures continue to happen the programs are decertified by Medicare, the primary insurer of kidney transplants. Accordingly, decertification can effectively end a transplant program.

While the intention behind the oversight is to improve the quality of care, it may ultimately limit access. Doctors fearing government penalties become more selective about the organs and the patients they accept, leading to more discards and less transplants. So while the success rates are higher it comes at a price.

Furthermore, the number of discarded kidneys has grown by 76 percent over the last ten years, which is more than twice the growth rate of transplant recoveries. Clearly, the system as it stands now is not working.

However, for the first time in 25 years the organization that governs organ transplants, the United Network for Organ Sharing (UNOS), is proposing a rules change away from the model currently in use. As part of the rules change kidneys with a low score (either due to age or some other factor) will be offered over a wider geographic region in an effort to reduce discards. Yet with regulations still in place it is difficult to imagine that this will have a significant effect.

A more important aspect of the rules change is a shift away from the first-come, first-serve model currently in use. As it stands now, organs tend to go to those who have been waiting the longest, which means that an elderly person may get an organ whose lifetime is much longer than its recipient. Under the new rules, 20 percent of kidneys expected to last the longest will go to 20 percent of patients with the longest life expectancy.

Yet this proposal may run into significant problems due to federal age discrimination laws. So reforming the system is much more difficult than it should be given a wait list that is more than 93,000 persons long and growing.

With a bevy of new regulations coming due to the Affordable Care Act, one has to wonder if the situation will become significantly worse. Given how ill-conceived many parts of the law have been, it seems that the answer is yes.