scholarly journals Value based care in nephrology: the Kidney Care Choices Model and other Reforms

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0004552021
Author(s):  
Gaurav Jain ◽  
Daniel E Weiner
Keyword(s):  
Kidney Disease ◽  
Organ Procurement ◽  
Deceased Donor ◽  
Home Dialysis ◽  
Live Organ Donation ◽  
Physician Leaders ◽  
Progression Of Kidney Disease ◽  
Organ Procurement Organizations ◽  
American Society ◽  
Value Based Care

The Advancing American Kidney Health (AAKH) initiative has reinvigorated the focus on improving the care of patients with advanced chronic kidney disease. Multiple interventions have been planned, with focus on education campaigns for both clinicians and patients, delaying the progression of kidney disease and improving utilization of home dialysis modalities and kidney transplantation. Value-based care models for patients with advanced kidney disease are being rolled out, with the ESRD treatment choices model starting in January 2021, and the Kidney Care choices model planned to start in January 2022. There is increasing emphasis on the role of the nephrologist as the "captain of the ship", leading efforts in care coordination as physician leaders. The transplant reforms have focused on changes to organ procurement organizations aiming to increase availability of organs, as well as transplants performed, both deceased donor as well as living donor, and removing financial disincentives from live organ donation. The American Society of Nephrology (ASN) and the National Kidney Foundation (NKF) are partnering with the Department of Health and Human Services to develop educational material for clinicians and patients. In this review, we discuss these reforms, as well as potential challenges that have risen, and potential solutions, with emphasis on the Kidney Care Choices model.

scholarly journals HIV+ deceased donor referrals: A national survey of organ procurement organizations

2018 ◽  
Vol 32 (2) ◽  
pp. e13171 ◽  
Author(s):  
Ayla Cash ◽  
Xun Luo ◽  
Eric K.H. Chow ◽  
Mary Grace Bowring ◽  
Ashton A. Shaffer ◽  
...  
Keyword(s):  
National Survey ◽  
Organ Procurement ◽  
Deceased Donor ◽  
Organ Procurement Organizations

scholarly journals Training Experiences of American Society of Transplant Surgeons Fellows in Deceased Donor Organ Procurement

2021 ◽  
Vol 105 (8) ◽  
pp. e87-e88
Author(s):  
Christopher R. Connelly ◽  
Ralph Cutler Quillin ◽  
Ben E. Biesterveld ◽  
Alexandra Highet ◽  
Austin D. Schenk ◽  
...  
Keyword(s):  
Organ Procurement ◽  
Deceased Donor ◽  
Donor Organ ◽  
American Society

Deceased donor kidneys allocated out of sequence by Organ Procurement Organizations

2022 ◽  
Author(s):  
Kristen L King ◽  
S Ali Husain ◽  
Adler Perotte ◽  
Joel T. Adler ◽  
Jesse D Schold ◽  
...  
Keyword(s):  
Organ Procurement ◽  
Deceased Donor ◽  
Organ Procurement Organizations

scholarly journals Trends in Discard of Kidneys from Hepatitis C Viremic Donors in the United States

2021 ◽  
Vol 16 (2) ◽  
pp. 251-261 ◽  
Author(s):  
Su-Hsin Chang ◽  
Massini Merzkani ◽  
Krista L. Lentine ◽  
Mei Wang ◽  
David A. Axelrod ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Organ Procurement ◽  
Deceased Donor ◽  
The United States ◽  
Nucleic Acid Amplification ◽  
Direct Acting Antiviral ◽  
Successful Transplantation ◽  
Organ Procurement Organizations ◽  
Hcv Antibody ◽  
Direct Acting

Background and objectivesKidneys from hepatitis C virus (HCV) viremic donors have become more commonly accepted for transplant, especially after effective direct-acting antiviral therapy became available in 2014. We examined the contemporary trend of kidney discard from donors with HCV seropositivity and viremia.Design, setting, participants, & measurementsData from the Organ Procurement and Transplantation Network were used to identify deceased donor kidneys recovered for transplant. The exposure was donor HCV antibody status in the first analyses, and donor HCV antibody and viremia status in the second analyses. Multilevel, multivariable logistic regression was used to assess the association of these HCV exposure measures with kidney discard, adjusted for donor characteristics. Multilevel analyses were conducted to account for similar kidney discard pattern within clusters of organ procurement organizations and regions.ResultsAmong 225,479 kidneys recovered from 2005 to 2019, 5% were from HCV seropositive donors. Compared with HCV seronegative kidneys, the odds of HCV seropositive kidney discard gradually declined, from a multivariable-adjusted odds ratio (aOR) of 7.06 (95% confidence interval [95% CI], 5.65 to 8.81) in 2014, to 1.20 (95% CI, 1.02 to 1.42) in 2019. Among 82,090 kidneys with nucleic acid amplification test results in 2015–2019, 4% were from HCV viremic donors and 2% were from aviremic seropositive donors. Compared with HCV aviremic seronegative kidneys, the odds of HCV viremic kidney discard decreased from an aOR of 4.89 (95% CI, 4.03 to 5.92) in 2018, to 1.48 (95% CI, 1.22 to 1.81) in 2019. By 2018 and 2019, aviremic seropositive status was not associated with higher odds of discard (2018: aOR, 1.13; 95% CI, 0.88 to 1.45; and 2019: aOR, 0.97; 95% CI, 0.76 to 1.23).ConclusionsDespite the decrease in kidney discard in recent years, kidneys from viremic (compared with aviremic seronegative) donors still had 48% higher odds of discard in 2019. The potential of these discarded organs to provide successful transplantation should be explored.

Sign in / Sign up

Export Citation Format

Share Document