By Jamie Ducharme
July 11, 2019

President Donald Trump on Wednesday signed an executive order aimed at streamlining the overburdened kidney care and transplantation system—a move meant to “bring new hope to millions of Americans suffering from kidney disease,” Trump said.

The policy is intended to improve kidney care in three major ways: by emphasizing more effective and convenient treatments; making more kidneys available for transplant; and improving preventive care and education with the goal of reducing the number of people who develop end-stage renal disease by 25% by 2030.

Kidney disease tends not to attract as much attention as other chronic conditions, such as heart disease and cancer. But though it flies mostly under the radar, kidney disease is the ninth most common cause of death in the U.S., according to the Centers for Disease Control and Prevention (CDC). About 37 million American adults have the condition, the CDC says, and more than 100,000 Americans—a disproportionate number of them African American—are waiting for a kidney transplant, according to the National Kidney Foundation. Many people at some stage of kidney disease do not know they have it, the CDC says.

Eliminating that information gap is a key part of the Trump Administration’s initiative. The new plan calls for the Department of Health and Human Services to launch a public awareness campaign about chronic kidney disease, and for the CDC to improve kidney disease tracking and detection nationwide. These initiatives—along with a change in Medicare provider payment models that would prioritize education and preventive care from doctors—are designed to help slow the rate at which Americans develop renal disease in the first place.

But the policy also includes a number of measures meant to improve care and quality of life for patients who have already been diagnosed, namely through updates to Medicare and Medicaid payment models. Payment model adjustments under Trump’s policy promote more widespread use of in-home dialysis, which is more convenient for patients. More than 500,000 patients were on dialysis in 2016, the National Kidney Foundation says, and many of them spend around 12 hours a week in dialysis centers, the Centers for Medicare and Medicaid Services (CMS) says. The current system is both burdensome to patients, and costly for the health care system as a whole.

“The way we currently pay for chronic kidney disease and kidney failure isn’t working well for patients,” CMS Administrator Seema Verma said in a statement.

The executive order also includes a proposal that would ease financial challenges for living kidney donors. While donors do not typically pay for their operations, they are often responsible for expenses like travel, lost wages and child care incurred as a result of the donation process—making it unattractive or impossible for many people, especially lower-income individuals, to donate. Trump’s order would cover many of these costs, which could increase participation by living donors and cut down on the number of people on the transplant waiting list.

In recent years, more kidney donors have been deceased than alive, according to the National Kidney Foundation. Here, too, Trump’s order seeks to improve the process, by streamlining an arcane organ procurement system that research shows allows a large percentage of usable organs to go to waste each year. Trump’s kidney program will more clearly define the standards that organ procurement organizations use to determine whether an organ is viable, with the goal of increasing organ recovery and closing geographic disparities in procurement rates.

Finally, the initiative looks toward the future by encouraging research into advancements like artificial kidneys, as well as better kidney disease treatments and prevention plans.

Write to Jamie Ducharme at [email protected].

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