Why kidney transplants are harder to get

Kidneys are by far the most in-demand organ for transplants. Yet Chicago-area hospitals are putting down their scalpels and taking on fewer cases.

In 2015, local transplant centers collectively performed nearly two-thirds fewer kidney transplants than they did just five years ago. Meanwhile, the waiting list for a kidney in Illinois reached its highest point in nearly 30 years in 2013 and has dipped only slightly since then.

The shift worries organ donation advocates, who blame the drop in transplants on hospitals being more cautious as federal regulations became more rigorous in the past decade. Last year, Gift of Hope, a nonprofit organ donation advocacy group in Itasca, sent more than 150 kidneys to patients in other states after Illinois transplant hospitals turned some of them down, the organization's CEO, Kevin Cmunt, says. Another 121 kidneys were used for research instead. Collectively, hospitals statewide performed 439 kidney transplants in 2015.

“Every day these regulations are out there causing the loss of organs and disadvantaging patients is bad,” Cmunt says.

The federal Centers for Medicare and Medicaid Services, which regulates the transplant industry, did not make anyone available for an interview. But experts say the federal agency enhanced its scrutiny on transplant programs to boost survival rates for patients and the organs they receive.

Illinois has nine hospitals that perform transplants, with seven of them in the Chicago area. It's a high-profile business that brings cachet to a hospital and its specialists. But transplants are among the riskiest procedures and therefore heavily monitored.

It's a balancing act for hospitals that are trying to keep up with the demand for transplants but risk being stripped of Medicare and Medicaid funding if they fall below CMS standards. They're also supervised by the nonprofit United Network for Organ Sharing, or UNOS, which sets its own standards for hospitals.

About half of the nearly 250 transplant programs in the nation were flagged for alleged shortcomings from 2007 to 2012. The CMS penalties are considered more severe since they involve potentially cutting off funding, while UNOS generally seeks to help hospitals improve their programs through a peer-review process.

Streeterville-based Northwestern Memorial Hospital, Loyola University Medical Center in west suburban Maywood and University of Illinois Medical Center on the Near West Side have been flagged by CMS in recent years.

At Loyola, from January 2012 to June 2014, regulators expected about 97 percent of adult patients to survive at least one year after their kidney transplants. But only about 94 percent did, federal data show. The hospital performed 61 kidney transplants in 2010 and half that number in 2015.

In a statement, Loyola spokeswoman Courtney Greve Hack says the hospital's “No. 1 priority is providing outstanding care, so we welcome any measure that will enhance our clinically integrated, evidence-based approach to care.”

Northwestern, which performs the most kidney transplants of any hospital in the state, did 278 procedures in 2010. Last year, it performed a little more than half that number.

The hospital supports Gift of Hope's efforts to change the federal guidelines, Northwestern spokesman Chris King says in a statement. CMS has made it “increasingly difficult” for transplant centers nationwide to perform the procedures without risking being flagged, he says.

A growing rate of diabetes, which can damage kidneys, has fueled the number of patients living with end-stage organ disease. At the same time, an aging population means the supply of organs available for donation is older and therefore less desirable.

“Northwestern Medicine's transplant center will continue to do what is best for our patients,” King says. “Having great clinical outcomes continues to be our goal, but no one should have to lose their life waiting for a transplant if an organ is available that can save them.”

In an email, U of I spokeswoman Sherri McGinnis Gonzalez says the hospital was flagged in 2014 after not meeting CMS' threshold for survival rates. It expects the CMS review to wrap up next month.

Dr. Yolanda Becker says she understands why transplant programs are more conservative these days. University of Chicago Medicine's kidney program was flagged when she arrived to oversee it in 2010. According to the most recent data, 98 percent of kidneys and 100 percent of patients at U of C survived at least one year after recent transplants. But Becker says she's still selective about which kidneys to use.

“Of course we want to all make sure we're performing safe transplants for patients and that our patients have the best outcomes,” says Becker, who is on the UNOS board. “The problem is we're getting regulated to a degree that we're a little risk-averse because none of us want our programs shut down.”

Dr. David Klassen, chief medical officer at Richmond, Va.-based UNOS, says the organization is embarking on several initiatives to make sure transplant programs are held to high standards yet can expand access to more patients. They include allowing about 15 hospitals to use riskier kidneys from dead donors and monitoring their performance.

If it succeeds, that could prompt changes at CMS. The federal agency closely watches what UNOS does and tends to adopt its methods, Klassen says.

"Why kidney transplants are harder to get" originally appeared on the website of Crain's Chicago Business.