The worsening transplant organ shortage in USA; desperate times demand innovative solutions

Editorial Implication for health policy/practice/research/medical education: The great success in the field of transplantation has made it possible to save many lives every year. Unfortunately, this success has been overshadowed by an ever-growing shortage of organs. The ever-widening gap between demand and supply has resulted in an illegal black market and unethical transplant tourism of global proportions. While there is much room to improve the Iranian model of regulated incentivized live kidney donation, the Iranian model could serve as an example for how other countries could make significant strides to lessening their own organ shortage crises. Please cite this paper as: Bastani B. The worsening transplant organ shortage in USA; desperate times demand innovative solutions. E nd-stage renal disease (ESRD) is a growing health concern in the United States. In the past 3 decades there has been an exponential, 1000%, increase in the number of ESRD patients The prevalence rate of ESRD has increased by greater than 600%, from 290 cases per million in 1980 to 1754 cases per million of population in 2010 (1). The causes of ESRD in the United States are diabetes mellitus (38%), hypertension (25%), glomerulo-nephritis (14%), renal cystic disease (5%), and other causes (18%) (1). The cost of ESRD has increased by 850% over the past 2 decades, from 5 billion dollars was paid by Medicare public funds, and 13.47 billion by private funds) (2). According to the United States Renal Data System (USRDS) report, in 2010 of the total Medicare spending of 522.8 billion dollars (3.95% of GDP), 32.9 billion dollars were allocated for ESRD patients (6.3% of the total Medicare budget), and thus, ESRD patients consumed 0.25% of the GDP of the United States (1). Among the 3 modalities of renal replacement therapy , i.e., hemodialysis, peritoneal dialysis, and renal transplantation, the latter has proven to be the most lifesaving, with a significantly reduced morbidity and mortality and a much-improved quality of life. The 85.5% 5-year patient survival for renal transplant is more than twice the 35.8% 5-year patient survival rate for dialysis patients awaiting transplantation (2). According to the USRDS report in 2012, of the total ESRD patients in the United States, 65% were supported with hemodialysis, 5% with peritoneal dialysis, and 30% had a functioning renal transplant. The yearly Medicare spending for an ESRD patient per modality was $87 561 on hemodialysis, $66 751 on peri-toneal dialysis, and $32 914 on …