Monday, October 14, 2019

PRE-TRANSPANT DEPOSITS: CAN YOU AFFORD A KIDNEY TRANSPLANT


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);

 


 

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);

 


 

 

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);

 


 

 

 

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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