How kidney transplant reforms can save lives and reduce the deficit

Legislation is needed to build a comprehensive national living organ donor support system consisting of three building blocks. 

For months, Congress has debated budget bill after budget bill, narrowly missing government shutdown deadlines seemingly every month. With a divided Congress and narrow majorities in both chambers, consensus on many topics seems hard to come by nowadays. 

Yet, lawmakers of both parties should embrace one area of reform that will save money and lives: kidney transplants and increasing living donations.

There are several reforms which, if properly aimed at improving the kidney transplant system, will save taxpayer money and improve healthcare outcomes. Currently, living kidney donation lacks meaningful federal support. While several nonprofits and dozens of transplant centers are doing impressive work, minimal federal resources are available to support individuals in need of a donation from a living donor and to support individuals who volunteer to donate a kidney and save a life.

Legislation is needed to build a comprehensive national living organ donor support system consisting of three building blocks. 

First, Congress must authorize kidney transplant navigators for transplant recipients and donors, building on the new Medicare “principal illness navigation” program. Second, Congress needs to clarify that living donors are entitled to appropriate cost reimbursement, building on existing law that already instructs Medicare to cover all reasonable expenses for living donors. And third, a national living donor education program should be adopted. Together, these key building blocks stack up to create common-sense legislation.

It is no secret that healthcare costs from programs like Medicare and Medicaid dominate federal spending. Billions are spent annually on necessary (but often preventable) care meant to improve and extend lives. But we should not blindly spend money on existing program choices. Focusing on living donors and not long-term dialysis treatment would be a remarkable structural shift that benefits both patients and taxpayers.

But don’t just take our word for it. We viewed a private report commissioned by Kidney Transplant Collaborative that found more than $6 billion in savings by replacing dialysis costs of approximately $150,000 per year per patient with a one-time transplant cost of $165,000, and ongoing immunosuppression drug costs of $27,000. Assuming only a modest growth in living donor transplants, the savings accumulate rapidly, and Medicare would save significant funds.

Although these changes and the benefits that come with them won’t appear overnight, they will save lives. We know that in 2023, more than 6,900 kidney transplants came from living donors, while more than 16,000 came from deceased donors. We also know that in the same year, nearly 90,000 Americans were waiting for a kidney transplant, with tens of thousands more in need of a transplant but not yet on the waiting list.

Today, the average wait is 3-5 years. And 17 people die each day waiting for an organ transplant, with tens of thousands more in need of a transplant but not yet on the waiting list. 

Despite the increase in deceased donors, the waiting list is simply growing too fast. Without change, we can unfortunately expect an increase in years on the waiting list, and deaths.

Lawmakers in Congress will continue to debate the merits of healthcare reform for years to come. And while voters voice concerns about health care prices and cost of living increases, these reforms offer us an opportunity to tackle both issues head-on. They are not just about ensuring the government is a good steward of our tax dollars, but will more importantly save the lives of kidney disease patients across the country.

As Congress continues to debate large-scale spending measures and long-term priorities, these provisions offer a non-controversial, common-sense plan for the nation's health and financial future.

Max N. Rose served as a member of Congress from New York from 2019 to 2021 and as a senior advisor to the Secretary of Defense. Thomas Reed II was a member of Congress from New York from 2010 to 2013.