PRE-TRANSPANT
DEPOSITS: CAN YOU AFFORD A KIDNEY
TRANSPLANT
Can you afford a kidney transplant in
America? Kidney transplants seem to go
to the people who can best afford it, are insured for it or can raise an
outrageous deposit for it. Although the
rules appear to suggest that kidney transplants go to the sickest patients, the
truth is, if you are deemed a financial risk, many centers require you to make
a pre-transplant deposit prior to your being placed on the waitlist, and to
maintain that balance until the time that you are transplanted. These deposits
are not cheap. They range from $10,000-$30,000. For a person that is ESRD and on dialysis,
who may or may not be working, this is a lot of money to raise and maintain
while on that waiting list. It is my belief that this discourages people from
seeking a transplant, resulting in catastrophic results. The struggle to raise and maintain this hefty
amount of money, just to get transplanted eliminates needy, sickly, yet worthy
candidates. It is grossly unfair, and
inequitable.
A
STUDY SUGGESTS THE WEALTY ARE TRANSPLANTED AHEAD OF THE TRULY SICK
A
recent study done by Dr. Raymond Givens and associates from Columbia University
Medical Center studied transplant data from 2000-2013. It resulted in the conclusion that people who
were affluent enough to afford to be listed in multiple geographic organ
transplant lists were more likely to receive organ transplants, than those who
could not afford to multiple list.
Despite being less ill, the multiple listers were receiving more
transplants. For example, people living
in New York, who could travel to Los Angeles obtained second listings,
enhancing their prospects of obtaining an organ transplant much sooner, than
someone who could not afford to multiple list.
The bottom line is that wealthier people were more likely to get
transplants and less likely to die waiting for a transplant.
The study found that the
medium average gross income for the multiple listers was $90,153, while the
people with just one listing had a medium average gross income of $68,986.
Here is
the point for our purposes. If you are
wealthy, you have advantages in obtaining a transplant, over the more sickly or
needy. The ability to pay for a
pre-transplant deposit, or to forego that option altogether, is one of those
advantages.
STATISTICS
-In 2017 on average 12 patients die every day in the
United States each day awaiting kidney transplants, more than 4,600 candidates
in 2017 died while on the waiting list, or within 30 days of leaving the
list for personal or medical reasons, without receiving a kidney transplant[i];
-According to UNOS, in 2018, 21,167 kidney transplants
were performed[ii];
-There are over 93,000 people awaiting kidney
transplants currently in the US;
-Currently, the average cost of a kidney transplant in
the US is $260,000, including pre-transplant screening, donor matching,
surgery, post-surgical care and the first 6 months of medications;[iii];
-Currently the average costs for anti-rejection meds
for a kidney transplant is $17,000/yr.;[iv]
-The difference in cost between average costs for
anti-rejection meds and costs for dialysis are striking. Transplantation and medical care costs after
the first year following surgery averaged $16,000, mostly for antirejection
medication. In comparison, a return to dialysis
costs average $70,000-$106,000 per year[v]. Medicare only pays for the first 36 months of
anti-rejection medications, and if you are under 65, you must have coverage or
be able to pay for the medications for the life of your transplant. If your kidney is rejected, mostly likely you
return to dialysis, which is completely covered by Medicare for the rest of
your life, at a higher cost.
-A recent study has shown that there is a cost savings
of between $73.4 million and $120 million over a decade by expanding payment
for immunosuppressant drugs to help patients avoid returning to dialysis or
undergoing additional transplants. This
savings could reach as much as $300 million[vi].
KIDNEY
TRANSPLANTS OFTEN DEPEND ON THE PATIENT’S FINANCES
The
concern of many transplant centers is whether the patient can afford the
anti-rejection medications that prevent your body from rejecting your
transplanted kidney, resulting in a removal of the kidney and the patient’s
return to dialysis. Almost all of the
nation’s 250+ transplant centers refer patients to a single national registry,
requiring the patients to verify how they will cover post-transplant bills
which can include $400,000 for a kidney transplant, plus monthly costs that
average $2500 for anti-rejection medications, that must be taken for the life
of your transplanted kidney. Coverage
for such medication is extremely difficult to find, less likely than the
transplant operation itself. This is despite the fact that the transplanted
kidneys will not last without the medicine. For this reason, kidney transplant
centers have linked a lifesaving treatment to your finances. Requiring proof of payment for organ
transplant and post-operative care is becoming more and more common. Without
the recommended pre-transplant deposit, the patient will not even be
listed. This is done to “prevent the
wasting of transplanted organs.” The
centers are basically saying, if you wish to receive a life-saving kidney
transplant, you must be able to afford it, when the basis should be if you are
sick, this is your opportunity. The
problem I have is that there are many other sources of help with payment for
anti-rejection meds that may go unexplored before rejecting the patient,
putting the less wealthy patient at risk for his/her life. The rich have an
unfair advantage when seeking a kidney transplant.
OTHER
POSSIBILITIES FOR COVERAGE
Nearly
half of the patients who are waiting for organs in America have private health
insurance, while the rest are covered mostly by Medicate and Medicaid. Medicare covers kidney transplants for all
patients with end-stage renal disease, but there is a catch. While a kidney transplant is covered for
people under 65, Medicare will only cover the costs of anti-rejection drugs for
36 months after your transplant. For
this group of patients, there may be bills for $3,000-$4, 000 a month. Recently,
two federal projections demonstrated that Medicare may save money paying
for anti-rejection medications for life as opposed to paying for dialysis in
the amounts between $73.4M and $120M over a decade, possibly reaching $300M in
that period. Legislation that would extend this time period has yet to even
receive a vote on the floor of Congress.
GoFundMe type efforts
have become more and more frequent in such cases. According to CNN, about 1/3rd
of campaigns on the GoFundMe site are for medical needs. Other organizations
that help include HelpHopeLive, the National Foundation for Transplants and the
American Transplant Foundation. It is of
note that sites like Go Fund Me may take a portion of the money raised, and it
may be considered as taxable income. Special plans for payment from the
manufacturer of the medications may also be available.
UNOS lists the following sources to consider:
·
Private health insurance;
·
COBRA extended employer group coverage;
·
Health Insurance Marketplace;
·
Medicare;
·
Medicare Prescription Drug Plans;
·
Medigap Plans;
·
Charitable Organizations;
·
Advocacy Organizations;
·
Fundraising Campaigns;
·
TRICARE & Veterans Administration;
CONCLUSION
There is a definite
disparity that exists between the have and the have nots, when it comes to
obtaining a kidney/organ transplant in the United States. It is an unfair, unreasonable and irrational
disparity that exists and is fueled by the 36 months coverage of anti-rejection
medications for transplants patients before you are own your own with very
expensive medication. The
immunosuppression Medicare rule must be changed. It is unreasonable to request an ESRD patient
on dialysis, who very well may be unable to work, to raise tens of thousands of
dollars and to maintain that balance until transplant. With an average wait time of 4-6 yrs. in most
states and almost a 10 yr. wait in the State of California, this is an unreasonably
long time to ask kidney patients to hold their breaths. A kidney/organ transplant is a life-saving
act. This is where the true focus should
be, on saving the lives of needy patients, not denying patients life-extending
medications or eliminating poorer patients from obtaining the only life-saving
option available. How many kidney
patients opt not to attempt a transplant solely based on costs? How many lose their listing because they
cannot maintain that required balance?
In this writer’s opinion, even just one is one patient too many.
SOURCES-GENERAL
REFERENCES
Lupkin, Good Luck Getting An Organ
Transplant If You’re Poor in America, https://www.vice.com/en_us/article/qv5jjb/good-luck-getting-an-organ-transplant-if-youre-poor-in-america
(November 12, 2015);
Aleccia, Kaiser Health News, ‘Wallet
biopsy’: Organ transplant often depends on patient’s finances, https://www.cnn.com/2018/12/24/health/organ-transplant-center-payment-partner/index.html
(December 24, 2018);
Aleccia, No Cash, No Heart.
Transplant Centers Require Proof of Payment. https://khn.org/news/no-cash-no-heart-transplant-centers-require-proof-of-payment/
(December 5, 2018);
UNOS, Covering Transplant Costs, https://transplantliving.org/financing-a-transplant/covering-costs/
(2019);
Whitlock, Ways To Pay For An Organ
Transplant Surgery, https://www.verywellhealth.com/how-to-pay-for-an-organ-transplant-surgery-3157022;
(July 28, 2019);
A
‘No-Brainer’? Calls Grow for Medicare to Cover Anti-Rejection Drugs After
Kidney Transplant, https://khn.org/news/kidney-transplant-anti-rejection-drugs-medicare-coverage/, (July, 2019)
ASSESSING
THE COSTS AND BENEFITS OF EXTENDING COVERAGE OF IMMUNOSUPPRESSIVE DRUGS UNDER
MEDICARE, U.S. Department of Health and
Human Services, Office of the Assistant Secretary for Planning and Evaluation, https://aspe.hhs.gov/pdf-report/assessing-costs-and-benefits-extending-coverage-immunosupressive-drugs-under-medicare, (5/10/2019);
Memo,
Department of Health and Human Services, Center for Medicare and Medicaid
Services, Office of Actuary, Proposal to Extend Coverage of Immunosuppressant
Drugs, https:// www.documentcloud.org/documents/6193012-OACT-Estimate-Extension-of-Immunosuppressive.html, (May 22, 2019);
Thomas, Cost of Immunosuppressive Drugs and the
Patient with A Kidney Transplant, https://cjasn.asnjournals.org/content/14/3/317,
(March 14, 2019).
SOURCES-SPECIFIC
REFERENCES
[i]
Email on October 1st, 2019 from Anne Paschke from UNOS
[ii]
2018 Transplants by Organ Type, Kidney, https://unos.org/data/transplant-tends/
(2019)
[iii]
Cost of a Kidney Transplant-Consumer Information, https://health.costhelper/kidney-transplant.html
(2019)
[iv]
Id
[v] Thomas,
Cost of Immunosuppressive Drugs and the Patient with A Kidney Transplant, https://cjasn.asnjournals.org/content/14/3/317,
(March 14, 2019).
[vi] A
‘No-Brainer’? Calls Grow for Medicare to Cover Anti-Rejection Drugs After
Kidney Transplant, https://khn.org/news/kidney-transplant-anti-rejection-drugs-medicare-coverage/,
(July, 2019);
ASSESSING THE COSTS AND BENEFITS OF EXTENDING COVERAGE
OF IMMUNOSUPPRESSIVE DRUGS UNDER MEDICARE, U.S. Department of Health and Human Services, Office of the
Assistant Secretary for Planning and Evaluation, https://aspe.hhs.gov/pdf-report/assessing-costs-and-benefits-extending-coverage-immunosupressive-drugs-under-medicare,
(5/10/2019);
Memo, Department of Health and Human Services, Center
for Medicare and Medicaid Services, Office of Actuary, Proposal to Extend
Coverage of Immunosuppressant Drugs, https:// www.documentcloud.org/documents/6193012-OACT-Estimate-Extension-of-Immunosuppressive.html,
(May 22, 2019);
Thomas, Cost of Immunosuppressive Drugs and the Patient
with A Kidney Transplant, https://cjasn.asnjournals.org/content/14/3/317,
(March 14, 2019).
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