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

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.

Join the Lone Kidney Club: incentivising live organ donation

Given the dramatic shortage of transplantable organs, demand cannot be met by established and envisioned organ procurement policies targeting postmortem donation. Live organ donation (LOD) is a medically attractive option, and ethically permissible if informed consent is given and donor beneficence balances recipient non-maleficence. Only a few legal and regulatory frameworks incentivise LOD, with the key exception of Israel’s Organ Transplant Law, which has produced significant improvements in organ donation rates. Therefore, I propose an organ procurement system that incentivises LOD by allocating additional priority points to the living donor on any transplant waiting list. I outline benefits and challenges for potential recipients, donors and society at large, and suggest measures to ensure medical protection of marginalised patient groups.

Imminent Death Donation: Ethical and Practical Policy Considerations

While the practice of organ donation after cardiac death has long been trending upwards in acceptance and use, it is still a highly controversial and practically inefficient method of organ procurement. One policy that has recently been proposed to try and alleviate some of the ethical and practical concerns with organ donation after cardiac death is the practice of imminent death organ donation. This type of live organ donation comes in patients at the end of their life who have decided to withdraw life-sustaining treatment, but still want to ensure that their organs are donated and not wasted, which isn't always the case with organ donation after cardiac death. This paper then gives some ethical and practical reflections and recommendations regarding the potential implementation of this controversial practice into regular transplant practice and policy.

Organ donation and transplantation: knowledge and attitude amongst Indian undergraduate medical students

Background: Organ donation not only saves the lives of dying people but also improves the quality of life of many patients. A huge demand supply gap exists between patients requiring trans­plantation and organ donors. Organ transplantation has become the only hope for some patients with damaged or failing organs to extend their life. This study was carried out to assess the knowledge and attitude towards organ donation and transplantation amongst the undergraduate medical students.Methods: A cross-sectional study was carried out amongst 98 undergraduate students of IIMSR Medical College, Badnapur, Jalna during the period of January to August 2016. Knowledge and attitude regarding organ donation were assessed using a pre-designed, pre-tested and validated questionnaire. Results were analyzed in the form of percentage and proportions whenever necessary.Results: In present study, only 35.71% students knew the definition of organ donation, whereas 46.94% and 51.02% students knew that what organs can be donated and who could be an organ donar respectively. Majority 71.43% students believed that who should make decision about organ donation in case of unclaimed dead body. Majority 82.65% students reported that live organ donation is better than cadaveric organ donation in solving shortage, 67.34% thought that donating one’s organ adds meaning to one’s life.Conclusions: Undergraduate students have inadequate knowledge, but have positive attitudes towards organ donation. There is a need to increase knowledge regarding organ donation among this essential group.

Research on MI in Equipoise: The Case of Living Organ Donation

Residual ambivalence prior to live organ donation has been shown to predict worse physical and psychological outcomes for the donor following surgery. We are studying whether MI can help individuals who have agreed to become living organ donors to resolve residual ambivalence about their decision. In this situation, ethical practice demands that the counselor take up a stance of equipoise, equally welcoming of strengthened resolve to donate or a decision not to do so. This paper describes our adaptations of MI for this unique applicatio