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September 10, 2019

Improving Access to Kidney Transplantation: Business as Usual or New Ways of Doing Business?

Author Affiliations
  • 1Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina
  • 2Center for Health Outcomes and Innovation Research, Duke University School of Medicine, Durham, North Carolina
  • 3Department of Population Health Sciences, Duke University, Durham, North Carolina
  • 4Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health System, Durham, North Carolina
  • 5Department of Medicine, Priscilla Chan and Mark Zuckerberg San Francisco General Hospital, University of California, San Francisco
JAMA. 2019;322(10):931-933. doi:10.1001/jama.2019.12784

Kidney transplantation saves lives, improves patients’ quality of life, and it is less costly in the long run compared with dialysis treatments.1,2 Despite this, kidney transplantation remains underused in the United States. Fewer than 20% of patients who initiate hemodialysis are placed on the deceased donor kidney transplantation waiting list or receive a kidney transplant within 1 year of dialysis initiation.3 A complex constellation of systemic factors contribute to low kidney transplantation rates, including low organ donation rates,4,5 organ allocation system rules,6,7 patient factors (eg, transplant knowledge and preferences),8,9 physician factors (eg, infrequent discussions about transplantation with patients),10 and health care organizational barriers (eg, suboptimal communication between dialysis facilities and transplant centers).11

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