Greenbeard
Gold Member
age discrimination was never a factor in making the best match. If this law passes it will be. Just be honest about it.
What law? Do you have any idea what's going on here?
Let me try and help you out. First of all, understand the basics: almost thirty years ago, the federal government authorized the creation of an Organ Procurement and Transplantation Network (OPTN), to be operated by a private non-profit under contract with the feds. The OPTN's function, put simply, is to allocate organs. Longstanding federal rules require the OPTN's Board of Directors to develop a policy for doing this that, among other things, "Shall be designed to avoid wasting organs, to avoid futile transplants, to promote patient access to transplantation, and to promote the efficient management of organ placement" and "Shall be reviewed periodically and revised as appropriate." You may think this is a death panel but it certainly isn't new; it was established under Reagan almost three decades ago.
Second, understand the concept here. The particular policy under discussion here is about the allocation of kidneys and kidneys alone. Transplants of other organs already take into account relevant factors besides the time a name has been on a list. Kidneys, on the other hand, are handed out rather blindly:
Organ allocation is the process the OPTN uses to determine which transplant candidates are offered which organs. Each organ allocation system attempts to achieve different goals. For example, livers are allocated based on a candidate’s chance of dying while waiting for a transplant. Those candidates at highest risk are transplanted ahead of candidates at lower risk. Lungs are allocated based on the candidate’s chance of dying while waiting for a transplant and also on the chance of dying during the first year following transplant. In this way, the liver and lung allocation systems both attempt to minimize death on the waiting list. The lung allocation system is designed also to maximize survival in the first year after transplant. Kidneys are currently allocated based primarily on how long a candidate has been waiting. This is not how the Kidney allocation system was initially designed. Initially, allocation priority was heavily weighted based on closely a candidate ‘matched’ a kidney by tissue type testing. In the past, closer matching was necessary for acceptable results. With improvement in anti-rejection medications, the priority for tissue typing has been decreased greatly over the last several decades. While the current design of giving most of the priority based on waiting time may be perceived as “fair”, it does not strive to minimize death on the waiting list nor promote maximize survival following transplant. It does not recognize that all candidates do not have the same ability to survive the wait. It does not attempt to match the characteristics of a donor’s kidney to the candidate’s characteristics to promote a long and healthy survival post-transplant. The system can be better and it can be designed to achieve more in the way of health and longevity than it currently does.
Third, understand the genesis of this current development. The OPTN's Board of Directors--those folks charged with devising the allocation policy that should "be reviewed periodically and revised as appropriate"--decided almost six years ago to review and revise their kidney allocation polices (which, as they noted in the quote above, they think aren't particularly good). So they asked their standing Kidney Transplantation Committee to address the issue.
How did this committee go about its work and what did it find?
In an effort to understand the current system’s limitations and opportunities for improvement, the Committee held a series of public hearings, two public forums, gave many presentations to stakeholders, and reviewed hundreds of submitted comments.
During the public hearings, the Committee heard from the transplant community that the limitations of the current system include the following:
- high discard rates of kidneys (especially those from expanded criteria donors [ECD]) that could benefit candidates on the waiting list,
- variability in access to transplantation by blood group and geographic location, and
- many kidneys with long potential longevity being allocated to candidates with significantly shorter potential longevity and vice versa. This results in unrealized graft years and unnecessarily high retransplant rates.
They laid out the goals for kidney transplantation that they came to with stakeholders via this open process (particularly from a public forum that the committee held in January of 2009) and have now come up with three proposals for improving the current kidney allocation policy:
- Utilizing a kidney donor profile index (KDPI) to better characterize donor kidneys and to provide additional clinical information for patients and providers to consider during the transplant evaluation process and organ offer process. The KPDI is a continuous measure used to estimate the potential function of a donated kidney if it were transplanted in to the average recipient.
- Allocating the majority of organs (80%) by age matching so that candidates within 15 years (older and younger) than the donor are prioritized. This is a 30 year time span around each deceased donor’s age.
- Allocating some kidneys (20%) by the combination of the kidney donor profile index (KDPI) and candidate estimated post-transplant survival (EPTS).
You, as a member of the public, are invited to review their proposal and provide feedback before April 1: you can read it and submit public comments here.
To sum up:
- No law has changed. The OPTN is reviewing its own policy, with stakeholder and public input.
- Organs are not all allocated indiscriminately, which is why the policy under review here pertains to kidneys, which, for the most part, are.
- The ACA ("Obamacare") has absolutely nothing to do with this.
- This "death panel" (the OPTN) has been death paneling since the mid-80s.
- This process of reviewing and potentially revising the kidney allocation policies began years ago.
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