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Waits and Measures: New Metrics, Allocation Revisions, and the Evolution of the Transplant Waiting List

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The vision includes:

  • Implementing a common information technology platform
    Provide all stakeholders real-time tracking of the status of transplant referrals, patient progress in the transplant evaluation process, wait-list activity status, and status updates once a patient is active on the list.

  • Supporting quality metrics that expand patient access to transplant and improve wait-list management, rather than box-checking
    Private payors and regulators should abandon the transplant rate and PPPW metrics in favor of metrics that reward collaborative, integrated wait-list management programs between transplant centers and dialysis facilities.

  • Inviting transplant personnel into Fresenius Kidney Care dialysis facilities
    Facilitate chart review, chairside in-person transplant education, and participation in monthly multidisciplinary continuous quality improvement (CQI) meetings. Doctors, nurses, social workers, and patient care technicians know Fresenius Kidney Care patients and have the tools and insights to position patients to succeed with transplant.

  • Using system solutions to identify and overcome surmountable barriers to transplant
    Many Fresenius Kidney Care patients are medically suitable but not socially, psychologically, or financially readyfor transplant. Building on Fresenius Kidney Care experience operating ESCOs in more than 30 markets around the country, FMCNA is committed to partnering with local transplant centers to create support programs for patients to find novel ways to bridge gaps in social support, transportation, and medication adherence.

  • Pressuring transplant centers to do their part
    High rates of organ discard do not serve patients well. Transplant centers must be encouraged and supported to do their part to increase access to transplantation by transplanting higher risk organs.


Effective wait-list management can increase the number of patients with access to kidney transplantation. Only with active, transparent collaboration between nephrologists, transplant programs, dialysis providers, and patients can a rational, consistent, and scalable delivery system be designed.

Meet Our Experts

BENJAMIN HIPPEN, MD, FASN, FAST
Medical Director, Fresenius Kidney Care; Partner, Metrolina Nephrology Associates, P.A.

Benjamin Hippen is a general and transplant nephrologist with Metrolina Nephrology Associates, P.A., and is a Clinical Professor of Medicine at the UNC Chapel-Hill School of Medicine. Dr. Hippen serves as the associate medical director of the kidney and kidney-pancreas transplant program at Atrium Health, and he serves as medical director of a Fresenius Kidney Care in-center hemodialysis and home therapies facility in Charlotte, N.C.

FRANKLIN W. MADDUX, MD, FACP
Global Chief Medical Officer, Fresenius Medical Care

Dr. Franklin W. Maddux's distinguished career encompasses more than three decades of experience as physician, expert nephrologist, technology entrepreneur, and health care executive. He previously served as Executive Vice President and Chief Medical Officer for Fresenius Medical Care North America and joined Fresenius Medical Care in 2009 after the company acquired Health IT Services Group, a leading electronic health record (EHR) software company founded by Maddux. He developed one of the first laboratory electronic data interchange programs for the US dialysis industry and later created one of the first web-based EHR solutions, now marketed under Acumen Physician Solutions. A practicing nephrologist for nearly two decades, Dr. Maddux graduated with his baccalaureate in mathematics from Vanderbilt University and holds his MD from the School of Medicine at the University of North Carolina at Chapel Hill, where he holds a faculty appointment as clinical associate professor. His writings have appeared in leading medical journals, and his pioneering health care information technology innovations are part of the permanent collection of the National Museum of American History at the Smithsonian Institution.

References

  1. Hippen BE. Debating organ procurement policy without illusions. Am J Kidney Dis 66(4): 577-82.
  2. Bowring MG, Massie AB, Craig-Schapiro R, Segev DL, Nicholas LH. Kidney offer acceptance at programs undergoing a Systems Improvement Agreement. Am J Transplant 2018 Sep;18(9): 2182-88.
  3. National Archives. Medicare and Medicaid programs; regulatory provisions to promote program efficiency, transparency, and burden reduction. Federal Register, Sept. 20, 2018. https://www.federalregister.gov/documents/2018/09/20/2018-19599/medicare-and-medicaid-programs-regulatory-provisions-to-promote-program-efficiency-transparency-and. 
  4. Fay, Koren. Transplant rate—a new metric to worry about? XynManagement blog, n.d. https://xynmanagement.com/transplant-rate-new-metric-worry/.
  5. Castro S, Fox A. Eliminate the use of DSAs and regions in kidney and pancreas distribution. OPTN/UNOS Kidney and Pancreas Committees Concept Paper, 2019. https://optn.transplant.hrsa.gov/media/2802/kidney_pancreas_publiccomment_20190122.pdf.
  6. Gustafson S, Weaver T, Salkowski N, et al. Analysis report: data request from the OPTN Kidney Transplantation Committee: provide KPSAM simulation data on effect of removing DSA and region from kidney/pancreas/kidney-pancreas organ allocation policy. Scientific Registry of Transplant Recipients, Dec. 7, 2018. https://optn.transplant.hrsa.gov/media/2768/kp_analysisreport_20181207.pdf.
  7. Hippen BE, Maddux FW. Integrating kidney transplantation into value-based care for people with renal failure. Am J Transplant 2018 Jan;18(1):43-52.