By Rich Berkowitz
The National Kidney Foundation has just launched a new initiative called End the Wait! It’s a worthwhile endeavor to expand the number of transplants. How could one disagree? As much as I think transplantation is a great cause and for many dialyzors the best form of renal replacement therapy, End the Wait's bang for the buck can only be limited.
On 6/30/08 there were 78,611 patients registered on the waiting list for a kidney transplant. According to a 2008 American Journal of Transplantation article abstract:
Growth in the number of active patients on the kidney transplant waiting list has slowed. Projections based on the most recent five-year data suggest the total waiting list will grow at a rate of 4,138 registrations per year, whereas the active waiting list will increase at less than one-sixth that rate, or 663 registrations per year.
As the waiting list grows, the number of transplants falls further behind the need (SRTR Graph), that’s for sure! Here is the number of transplants since 1997.
Now compare that to the number of people on dialysis.
The numbers of transplants are a small compared to the number on dialysis. How many more transplants will result from the NKF's additional spending? When you consider living donors are usually family or friends who don't need any additional motivation, the NKF's efforts can only really increase cadaver donations.
So where should the dollars go? It certainly doesn’t seem like transplantation is helping very many of those who have CKD5 and the prospects are not that much greater in the future, so maybe the dollars ought to go toward making dialysis the best it can be. Everybody that reads DSEN is aware that home dialysis modalities give dialyzors better outcomes and longer survival rates than incenter conventional hemodialysis. With the mortality rates as high as they are in the U.S., it’s unconscionable to ignore the modality used by the vast majority of CKD5 patients. Why does the NKF target their efforts just towards transplantation?
Perhaps promoting transplantation with the “Gift of Life” moniker is sexier than talking about dialysis; perhaps they’re marching to the beat of their corporate sponsors. Is the NKF's mission to assist those with severe CKD or serve the interests of its benefactors, and thereby insuring its own existence? Is this just one more reason why what the CKD community needs an organization which is free of corporate involvement?