There Should Be An Urgency To Increase The Number Of Kidneys Available For Transplant

The United States has a government agency solely devoted to reducing automobile deaths in the United States, and it spends billions of dollars each year—and requires auto companies to do likewise—in an attempt to make our nation’s roads and the cars that travel on them safer.

However, more people die from kidney disease than from automobile accidents, but we lack any concerted effort to reduce these deaths. There are things we could be doing—or doing better—to help more people get kidney transplants, but the lack of urgency to address this means that many people needlessly die from this affliction, which disproportionately affects Hispanics, African Americans, and Native Americans.

We do spend a lot of money to care for people with end-stage renal disease: Over half a million people are currently on dialysis, and the federal government alone spends over $100 billion a year providing the treatment to people on Medicare, but living on dialysis is debilitating and it makes working and most other daily activities difficult.

Right now the only cure for someone with end-stage renal disease is a kidney transplant, but we have an enormous shortage of kidneys available for transplant: almost 25,000 Americans received a kidney transplant in 2021, but we need two to three times as many kidneys to alleviate the shortage.

There are three distinct efforts at the moment with the goal of increasing the amount of organs available. The first is to improve the performance and accountability of the 56 Organ Procurement Organizations—each assigned a fixed region of the country—that are tasked with procuring kidneys from willing donors—deceased or living—and getting them to those most in need of one.

Right now their performance varies widely: In some markets the rate of kidneys procured per decedent is two or three times that of other OPOs, with no apparent reason for the disparity. It is not uncommon for organs to be lost in transit, and the software to keep track of organs is antiquated or nonexistent.

The second way to boost the availability of kidneys would be to compensate live donors for the costs they incur in the process. The National Organ and Transplant Act prohibits paying people to donate, but the government can compensate them for the costs they incur traveling to and from the hospital as well as lost wages, childcare, or health costs not covered by insurance. One study estimated these costs average $38,000, and alleviating them would induce more people to make such a life-saving gift. The Trump Administration did issue an executive order to provide more funds to cover such costs, but the final regulation excluded anyone with an income over 350 percent of the poverty line from receiving any reimbursement, which greatly limited its efficacy.

However, even radical improvements in OPO performance and cost reimbursement reform won’t get us there.

Fortunately, scientists have begun making considerable progress in the use of xenotransplantation by creating kidneys suitable for human transplant in pigs, which holds the promise of a permanent fix to our kidney shortage.

Xenotransplantation science uses gene-edited pigs that are bred to allow for their kidneys or livers to be conducive for human transplants. If successful, this could make an abundant supply of organs for transplant available in the next decade or two.

Eliminating the shortages of available organs is not the only benefit of xenotransplantation science. Gene editing is being used to modify the donor animals to eliminate antigen blockers, which can dramatically lower the immune response in people, potentially allowing transplant recipients to forgo taking autoimmune drugs. Such an outcome would dramatically improve the health outcomes and reduce the long-term cost of care.

U.S.-based Makana Therapeutics recently obtained a European patent for its pig that employs this gene editing innovation. Transplant surgeon Joe Tector, founder of Makana Therapeutics, is in talks with the U.S. FDA to launch first-even human clinical trials through the Miami Transplant Institute.

Over 500,000 people are currently on dialysis in the United States—a painful and debilitating procedure—and 100,000 are currently on a transplant waiting list. Figuring out a way to solve this kidney shortage should be a matter of great urgency, but after spending a decade working on this issue I can tell you that few within the government appear to feel that way about it.

Solving this shortage would not only save tens of thousands of lives each year but it would also save the government tens of billions of dollars. It behooves us to hasten a solution to this terrible problem by supporting all efforts to obtain more kidneys.