Friday, September 11, 2009

Patients who think they can't find a kidney transplant match shouldn't give up

By CLARE HOWARD Journal Star

Advances in medicine have outpaced public policy and public understanding about kidney transplants, creating both hope and frustration.

Jim and Rosemary Stuttle feel both.

They turned to Northwestern Memorial Hospital in Chicago after learning they could not proceed with a living kidney transplant at OSF Saint Francis Medical Center in Peoria because of a switch in their insurance coverage.

What they learned going through the procedure at Northwestern is that patients who think they can't find a match have reason to hope. The hospital is expanding the pool of suitable donors.

At most transplant centers, blood type compatibility is necessary. Northwestern is one of a few centers nationwide offering a technique called ABO incompatible transplantation that desensitizes incompatible blood types and makes organ donation possible.

The hospital also is working on a paired exchange program matching kidneys among couples. Even if a couple is not a suitable match themselves, they can join a Northwestern patient database searching for matches. The record for the hospital was eight concurrent surgeries with kidneys removed from four people and transplanted to four others. The potential number of pairs expands when a good samaritan donor steps into the pool. Right now the hospital's data base includes just patients at Northwestern.

Dr. Joseph Leventhal, director of the living kidney transplant program at Northwestern, is Jim Stuttle's surgeon. Leventhal said there are currently pilot programs for regional exchange databases. Work is under way to establish a national database searching for compatible matches.

He said it's a common myth that donors must be related. Unrelated but compatible matches for a transplant means life expectancy for the donated kidney is 20 years, compared with 10 years for a cadaver kidney.

Expanding the donor list is critical. Nationwide, 100,000 people are waiting for organs, and three-fourths of them need kidneys.

Last year, 166 living kidney transplants were done at Northwestern, and this year volume is expected to increase 10 percent. The hospital performs the most live kidney transplants of any medical center in the world.

Leventhal, who has a Ph.D. in immunology as well as a medical degree, said immunosuppression drugs have side effects, but current research at the hospital is focused on using stem cells from bone marrow of the donor to minimize or even eliminate the rejection risk for the transplant recipient.

About 85 percent of kidney failure is due to diabetes and high blood pressure. Leventhal said proper preventive medicine can control these risks, but in America people without health insurance often receive no preventive care.

Leventhal said he's a firm supporter of a health care system that provides preventive care for everyone.

Dr. Anton Skaro, Rosemary Stuttle's surgeon, said, "There are steady advances being made with good research and new medicines that mean huge improvements in patients' quality of life, but there are still a lot of myths about transplants. The donor does not pay. Some of this progress has come about because the transplant community has a strong lobby in Washington. It makes economic sense to push for organ transplants."

Jim Stuttle said Medicare covers kidney transplants and three years of anti-rejection medication following surgery. Medicare covers dialysis with no time limit. That means people without insurance or financial resources are pushed from the less expensive option to a more debilitating and more expensive option. They lose their kidney transplant because they can't afford anti-rejection medication.

The cost of a kidney transplant is about $100,000. Dialysis costs more than $70,000 a year. Anti-rejection medication costs about $4,000 a month, but generics are now available, reducing that cost.

This is an area where public policy has not kept pace with advances in medical treatment, Leventhal said.

Skaro said, "Look at the costs and compare year to year the cost of dialysis. Transplants pay off. By the second and third year, transplants pay dividends. Pushing transplants would put $4 to $6 billion back into the system."

Returning to a job and productivity is greatly enhanced with a transplant versus dialysis, Skaro said, furthering the economic advantage of transplants.

Because Northwestern is a virtually steroid-free transplant center, meaning patients are rapidly weaned from steroids, they do much better with quality of life issues.

"We have patients who are able to return to work in weeks," Skaro said.

Jim and Rosemary Stuttle returned home to Peoria Friday, nine days after their kidney surgery. Rosemary Stuttle expects to get back to e-mail communication with her office and return physically as soon as she can drive in a week or two. Her husband works from home, so his return to work could be even sooner.

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