A physician discusses the future of kidney transplantation

Each day in the United States an average of 13 people will die waiting for a kidney transplant.

But the potential to save these individuals is possible with better use of donated organs and more living kidney donors, according to Silas Norman, M.D., University of Michigan Health Associate Transplant Center Director.

To that end, U-M Health will now be participating in one of the most advanced programs in the nation, the Increased Organ Transplant Access model, to ensure the ongoing success of its own Kidney Transplant Program.

The Increased Organ Transplant Access is a new model from the Centers for Medicare & Medicaid Services Innovation Center designed to increase kidney transplantation by incentivizing transplant centers to perform more transplants, improve care coordination and efficiency and create a more patient-centered focus in care delivery.

Here, Norman shares his thoughts on the model and its impact on the future of kidney transplants.

Why is the Increased Organ Transplant Access model important for transplant recipients?

Norman: We know there are many more people waiting for kidney transplant than the organs we have available.

Those on the waiting list often wait three to six years for a transplant.

For many, the waiting period is too long.

Improving transplant access through IOTA could be lifesaving for these individuals.

Building on other recent CMS models designed to optimize dialysis and transplant care, the IOTA model focuses on five areas to improve transplant care: 

• Maximizing the use of deceased donor kidneys

• Improving access to living kidney donation

• Addressing barriers to transplant access

• Improving care coordination

• Improving the quality of care across the transplant care continuum 

IOTA is structured so that half of the donor service areas in the country, including Michigan, will participate in the IOTA model.

U-M Health has worked with the Organ Procurement and Transplant Network to increase organ transplant. How will this model be advancing this effort?

Norman: Despite the number of people waiting for an organ transplant, many potentially transplantable organs are discarded every year.

The IOTA model helps address this issue by encouraging transplant centers to accept more organs and encourages identifying and removing barriers to successful transplantation.

At U-M Health, we are working to educate patients about their options for timely transplantation, thinking creatively about how we support patients before and after transplantation and modifying our transplant medication regimens to best support more marginal donor kidneys working successfully.

How will these efforts to increase organ transplant be done?

Norman: First, we’re working to make sure as many of the patients on our waiting list as possible are ready for transplantation.

Specifically, making sure all testing is up to date and that people are physically and psychosocially ready for their transplant offer.

We’re modifying the medication regimens we use to be more effective.

We have ongoing educational offerings as well as new partnerships to encourage and support living kidney donation.

We’re working closely with our patients’ local doctors to better coordinate care and to offer care locally whenever possible.

How will your role help move these efforts forward?

Norman: I work closely with our nursing, surgical and administrative partners to continuously look at how we can more effectively serve our patients.

The focus of my work is on the ambulatory or outpatient side of our transplant work across each of our organ transplant programs: kidney, liver, lung and heart. We recognize that to improve access and to be patient-centered, we need to deliver care close to where people live and work.

Not only is this more convenient for patients, but with local care, a patient’s support network is more likely to be able to participate, thus we can save patients the costs of transportation and lost work time involved when driving to U-M Health in Ann Arbor.

With that in mind, we are expanding and strengthening our outreach clinics.

We have clinics spread across the state, most recently in Traverse City.

In addition to pre-transplant evaluations, we are delivering some post-transplant care locally and trying to do as much of the required testing as possible locally.

Some of our clinics will offer access to more than one transplant organ, for instance clinics where both kidney and liver transplant providers see patients, further improving coordination of care.

How will increasing organ transplants benefit the patients you see?

Norman: There are currently over 90,000 people nationally waiting for kidney transplants, including 2,300 here in Michigan.

In contrast, just over 27,000 kidneys were transplanted last year.

A record achievement, but well short of the need.

If we can better utilize donated organs, we have the potential to successfully transplant people and get them back to the lives that end-stage kidney disease is interfering with.

Does this optimization of organ usage spread to living donors as well?

Norman: Absolutely. We know that a living donor kidney is the best way for someone to receive a kidney transplant.

The quality is often better, and we can get people transplanted more quickly, when they are most healthy, using living donor kidneys that tend to last longer.

Currently, there are barriers to living donation.

The first barrier is a lack of awareness of the need.

We have classes for patients and potentially interested donors to educate themselves about the process and safety of being a living kidney donor.

There can be barriers, such as lost work time for donor candidates and ease of navigating the transplant system.

There are systems in place to help offset donor costs and we are working as a team to improve living donation efficiency.

One important new partnership is called “Give to Live,” an organization that works directly with our patients to help them identify potential donor candidates and to help walk donors through the process.

What else should referring physicians and their patients know about the U-M Health Kidney Transplant Program specifically?

Norman: This is an exciting time in transplant. 

The U-M Health Transplant Center is focused on getting our patients the right kidney at the right time.

We would encourage physicians and their patients with advanced chronic kidney disease or on dialysis to contact us so we can get them started in the transplant process.