Kidney Donations: “Arc of Change” From Removing Disincentives to Testing Incentives

[Zach]

AST/ASTS Workshop on Increasing Organ Donation in the United States: Creating an “Arc of Change” From Removing Disincentives to Testing Incentives
Article first published online: 31 MAR 2015

Abstract
The American Society of Transplantation (AST) and American Society of Transplant Surgeons (ASTS) convened a workshop on June 2–3, 2014, to explore increasing both living and deceased organ donation in the United States. Recent articles in the lay press on illegal organ sales and transplant tourism highlight the impact of the current black market in kidneys that accompanies the growing global organ shortage. We believe it important not to conflate the illegal market for organs, which we reject in the strongest possible terms, with the potential in the United States for concerted action to remove all remaining financial disincentives for donors and critically consider testing the impact and acceptability of incentives to increase organ availability in the United States. However, we do not support any trials of direct payments or valuable considerations to donors or families based on a process of market-assigned values of organs. This White Paper represents a summary by the authors of the deliberations of the Incentives Workshop Group and has been approved by both AST and ASTS Boards.

For the full report:
http://onlinelibrary.wiley.com/doi/10.1111/ajt.13233/full
Also attached pdf for IHD members.

[Zach]

Any thoughts?

[okarol]

The changes have slowly evolved over many years, so I wonder what the future will bring.

[cassandra]

I suppose 'disincentives' in the States are different from those in other countries. In the UK all financial losses for all possible donors are already reimbursed. All healthcare is always 'free' as there is the NHS. Yet there is a black market because the shortage stays.

The only countries with a 'smaller' shortage are countries with an 'automatic' donation-system.

[MuddyGurl]

Bear with me this relates…the NEED for dialysis for the triumvirate group comprising: diabetics, kidney disease patients , and the obese means MORE need for dialysis and transplants as the study indicates.  Can we STOP or SLOW this problem  with dietary education NOW?

The USA is already up 600% in dialysis patients since 1980…. with the last 40 years of bad diet based on the PUSH by the USDA to consume  high grains over natural fats .  Americans listened to this advice and butter and egg consumption dropped over 13%..but at the same time we now have  a rise, to 70% overweight and obese..with all the medical issues like diabetes and kidney disease, CVD (caused by grains not fats)  increased too.

I am often a broken record for people in some  Low Carb High Fat diet groups who are eating massive amounts of meat and bacon without knowing their kidney status.  THESE are the future people who will need dialysis, and want transplants. It is NOT the fats they eat..it's overeating meat protein.

what is making me fearful is the VERY people who need to lose weight are
1. older
2. often are pre diabetic or diabetic
3. have CKD and do not know it..
4. have metabolic and other health issues
5. can't exercise as much

so many of them, while on what is a MUCH BETTER diet than high carbs/grains…are still damaging their already  weaker kidneys with so much meat protein.
(yes, healthy kidneys can have meat protein..but how many are healthy  who came to tthese diets?)

LC is NOT high protein, it is moderate….but Americans already eat double the rest of the world at over 100 grams a day, when <56 grams is recommended..so when they find this 'diet' they really go to town.   True, higher fat satiates sooner, so most aren't eating 5,000 calories. and they are getting healthy saturated fats, and avoiding veggie oils and transfats ( the really bad players).  and it's hard to chew 12 oz of steak 3x a day..so there is some limitation.

Nephs in the US do not much support vegetarian diet.. considering it a 'lesser' protein source..when that is it's very Benefit. CLK patients can eat many more foods with phosphorous and potassium once meats are eliminated or reduced significantly, since most meats  are higher in phosphorous.It's a trade off.

So they are encouraged from all sides, the MD, the Neph, the RD ( who is trained in high grain diet), the comfortable custom of high meat eating.

These are the SAME people who are part of the 26 MILLION with unknown kidney disease…so while they may lose some weight, they are dropping in kidney function too, over time, and will get a rude surprise when they are Stage 4 suddenly.

The USDA is being petitioned to change their dietary policy for 2015 away from continued low fat, high grains ( it's revised every 5 years) So we NEED to have  much better understanding of NUTRITION FIRST as a preventive for CKD and reduce the need for future transplants.

EDUCATION  for people 40 and over about CKD is one step, preventing diabetes with a LCHF diet is another. But many can't envision the future, and would rather take a pill or expect medical science to save them later, while they eat the wrong foods now.

think it will happen???
( I already know MOST patients say" everything in moderation" which is proven to be bad health advice in the long run)  We just do not want to give up the Standard American Diet.

[MuddyGurl]

MORE ON DIET/NUTRITION TO AVOID CKD/DIALYSIS

I found this Dr.and the excellent discussion on vegetarian over meat diets for CKD…plus in looking at a  statement from 2013 from Jeffrey Berns, Editor-in-Chief of Medscape Nephrology on the horrific rise in CKD/renal disease I think we can see the 'writing on the wall"
   
Numbers of Renal Disease Cases is Astounding
This allowed them to estimate the lifetime risk of developing CKD in patients who didn't already have CKD, and to estimate the progression through the various stages of CKD.

The numbers are quite astounding. The residual lifetime risk of developing CKD was:

• Stage 3a or higher CKD: 60%-70% (depending upon gender and ethnicity);

• Stage 3b or higher CKD: 30%-40%;

• Stage 4 CKD: 10%-20%; and

• ESRD: 2%-9%.

http://ihatedialysis.com/forum/index.php?topic=29693.msg467804#msg467804

Treating Kidney Failure Through Diet
Not only do plant-based diets appear to prevent kidney function decline, they may also be used to treat kidney failure. Even at the same protein loads, the body is able to better handle phosphorus excretion from plant-based diets, reducing the risk of metastatic calcification.

http://nutritionfacts.org/video/treating-kidney-failure-through-diet/

[cassandra]

So I understand that the discussion has side tracked a bit from the need for change to remove disincentives to donate kidneys, and other organs for transplantation, to why that need is growing.
I've always wondered why the amount of 'additives' in food wouldn't be a good place to start, or the amount of meds taken OTC and prescribed with warnings not to take with reduced renal function. And don't forget age, and how much longer people live quite healthily, and chronically ill people live longer too so they're more likely to develop renal problems due to meds. Cancer treatments can cause renal problems too. Food poisoning can cause renal/organ failure. And that's without counting the consequences of medical misstakes which cause renal problems. And the amount of heavy metals and chemicals in our environmental.
And than the amount of money to be made from D.....
I'm glad D exists, but sometimes....
And why no automatic donation system when one dies unless you've registered against?