Check out the latest RFN Poll of the Week, this time regarding the Fistula First campaign. A useful pdf describing the Fistula First’s Strategic Plan for achieving their goal of 66% prevalent AVF use, including their position on “Pay-for-Performance” strategies with respect to vascular access, can be found here.
Final results of last week’s Poll of the Week: only 13% of individuals said they outright disapproved of the proposed Kidney Allocation Score, the scoring system which has been proposed to replace the current system of determining kidney transplant organ allocation.
I had discussed on a previous post the motivation behind this plan. In general, the increasing number of elderly individuals going onto the kidney transplant waiting list has skewed kidney transplant recipients towards older patients. Critics of the current plan point out that since “waiting time” plays such a major role in determining organ allocation, by the time ESRD individuals are considered for an organ, they have accumulated multiple morbidities which may limit the lifespan of both patient and kidney. Furthermore, there is also a perception that the current plan does not do a good job of “matching” appropriate kidney donors with recipients: a young, healthy donor kidney with a projected longevity of several decades might be matched with an elderly diabetic; conversely, a borderline kidney might be matched up with a young recipient who as a result might require a second or even third transplant later down the line.
The KAS attempts to address these issues, but not surprisingly, it still has its detractors (see this editorial by Hippen in a recent issue of KI). Critics of the KAS have suggested that the proposed system is “ageist” (e.g., favoring younger patients at the expen
se of older patients), unfair to individuals who have already been “waiting in line” based on the previous system, and furthermore may have unintended consequences–for instance, if younger patients know that they are more likely to get a cadaveric transplant in a short period of time, there would be less incentive for them to obtain a live, donor kidney from a friend or family member which might last longer for that patient AND expand the number of donor kidneys in the societal pool.