Transplant society president calls for more collaborative efforts to increase organ supply
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The transplant community, HHS and procurement organizations need to work collaboratively to increase the organ supply for transplantation in the United States, according to remarks made at the American Transplant Congress.
“We need more than symbolic gestures from our elected officials if we are going to meet the crisis of end-stage organ failure that kills patients at a rate of 17 per day [on the waitlist] in the U.S.,” John Gill, MD, outgoing president of the American Society of Transplantation (AST), said during his address.
On April 7, Canada Post released this stamp encouraging Canadians to donate organs. More than 4,400 people are waiting for an organ transplant in Canada. Canada Post, copyright 2022. Posted with permission.
Gill, a transplant physician and a professor of medicine in the division of nephrology at the University of British Columbia in Vancouver, said efforts to improve organ donation start with the transplant community. He cited a statement made by former AST President William Braun during a U.S. congressional hearing in 1990 that said, “The wonder of what transplantation was is now a perfunctory performance.”
“What he was saying is that the magic of transplantation and this miracle of modern medicine had now waned in the eye of the public consciousness and was being overwhelmed by other medical feats,” Gill said. “He thought that was important because we need to stay connected with the public for our field to prosper. We need to reignite the excitement and the medical achievements” that the specialty has accomplished since the first kidney transplant was performed in December 1954 by surgeons Joseph Murray and John P. Merrill on identical twins, Gill said.
The congress, being held in Boston, marks the 40th anniversary of the AST, which was founded in 1982 as the American Society of Transplant Physicians. The organization has grown from 295 members to 4,250 members, Gill said. AST publishes the American Journal of Transplantation.
Gill said AST “has never been more important than it is today” to advance efforts in organ transplantation. He pointed out the diversity of AST leadership, including five past presidents who were women, four presidents who were persons of color, “and we even had four surgeons lead our society,” Gill said.
Likewise, protection and fair treatment for the living donor is imperative, Gill said. In the United States, Medicare does not offer health care coverage to organ donors unless they qualify due to age. “For [organ] donors to Medicare-insured recipients, long-term health care costs are covered only if directly attributed to donor surgery,” Gill said.
All health care costs for donors are covered in countries with universal health care, he said. “Surveillance and treatment of conditions that might compromise residual kidney function should be covered,” he said. “Coverage should be determined by the relationship to donor surgery and the potential to compromise post-donation kidney function” for the donor, he said.
He sees promise in a new law starting in January that will expand immunosuppressive drug coverage for patients with a transplant – “a 20-year endeavor,” he said.
Gill said metrics are important in organ donation, but “we need metrics that are of value to the patient and not to the payer.” What is of more value is for the transplant community to provide “patient-centered, culturally safe care to every potential deceased donor family, and if we did that, we are confident that members of the public would respond by providing life-saving organs,” he said.
“The challenge is not really picking the right outcome assessment – that is the easy part,” Gill said, referring to the success of organ transplantation. “The challenge is aligning all the actors who would be responsible for maximizing this multi-dimensional outcome with all the care providers that touch our patients and for us to recognize that is a large group. We need a system designed to achieve that.”
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Gill J. Presidential address. Presented at: American Transplant Congress; June 4-8, 2022; Boston (hybrid meeting).
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