Chicago needs kidneys but sends many to other states

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Chicago needs kidneys but sends many to other states[
By David Wahlberg


At the University of Illinois at Chicago, nearly 800 patients await kidney transplants.Dr. Enrico Benedetti, co-director of the transplant program, is reluctant to operate on most of them.The federal government cited his program last year for success rates that were lower than expected, given the mix of patients and quality of organs used. To become compliant, Benedetti said he must be extra careful about which organs he accepts and which patients he puts them in.“We’re forced to really pick and choose,” he said. “We’re letting people die on the list.”
Similar risk aversion at other transplant centers in Chicago has led Gift of Hope, the area’s organ procurement organization, to send less-than-ideal but viable kidneys to transplant centers in California and other states, said Kevin Cmunt, Gift of Hope’s president and CEO.The situation turns the normal forces of transplant on their head.“I don’t have a supply problem,” Cmunt said. “I have a demand problem.”
Federal regulators and private insurers started requiring transplant centers to have adequate success rates about eight years ago, sparking debate about whether the push for perfection has undermined efforts to do more transplants.“It’s counterintuitive,” said Dr. Ajay Sahajpal, medical director of the transplant program at Aurora St. Luke’s Medical Center in Milwaukee, where the government cited the liver and heart programs.Regulators mean well, but “they’ve taken it to the extreme and lost focus,” said Sara O’Loughlin, transplant administrator at Froedtert Hospital in Milwaukee.Thomas Hamilton, head of transplant certification for the federal Centers for Medicare and Medicaid Services, said forcing programs with low success rates to improve or dissolve has saved lives.
The government has cited 150 programs since 2008, of which 133 agreed to make improvements and 17 folded, Hamilton said.Over the subsequent five years, success rates for kidney transplants a year after the procedure increased from 93.1 percent to 95.4 percent, and success rates for liver transplants went from 84.7 percent to 89.2 percent.“There are many remarkable stories of improved medical care here,” Hamilton said in an email. “There is a strong national trend of increased patient survival.”
Milwaukee, Chicago hospitals citedThe government has not cited UW Hospital, but private insurers Humana and OptumHealth took UW Hospital off their lists of preferred kidney transplant centers from 2008 to 2010, citing lower-than-expected success rates.Froedtert hasn’t been cited by the government, but OptumHealth downgraded two of its programs.Aurora St. Luke’s liver program, cited by the government in 2010, was found to be in compliance in 2012. Its heart program was cited in 2012 and deemed in compliance the same year.In Chicago, the liver and heart programs at Rush University and the University of Chicago were cited but are now in compliance.
Last year, the government cited the liver program at the University of Chicago and the kidney programs at Northwestern Memorial Hospital and the University of Illinois at Chicago. The University of Chicago and Northwestern are back in compliance, and the University of Illinois at Chicago is working on improvements.Benedetti said government evaluations of success rates don’t take into account the low socioeconomic status of patients at centers like his.More than three-fourths of his patients are black or Hispanic, and many are poor, he said.“It’s discrimination,” he said. “These people can only count on us.”
Sending kidneys to California
Partly because Benedetti and other Chicago doctors turn down kidneys, Gift of Hope sends many out of the area, Cmunt said.
During the first three months of this year, 67 kidneys from Gift of Hope were transplanted in Illinois and 43 were sent to other states.
The out-of-state center that took the largest number — seven — is more than 2,000 miles away: the University of California, Davis Medical Center in Sacramento.Davis, the largest deceased donor kidney transplant program in the country, is known as the center of last resort for kidneys others refuse.
Many of the kidneys Davis transplants are from high-risk or very young donors, come with anatomical damage, have been out of the donor’s body a long time or present other complications.Davis pumps the kidneys with preservation solution to make them last longer, and on-call staff read biopsies and find willing recipients day or night, said Dr. Christoph Troppmann, a transplant surgeon at the center.
Yet the center’s transplant success rates are as expected or higher.“We invest an enormous amount of institutional resources into these organs,” Troppmann said.Dr. Dixon Kaufman, transplant chairman at UW Hospital, said UW takes similar steps and uses some kidneys with complications.
But with more than 2,600 kidneys discarded nationwide each year — nearly one in five of kidneys recovered from donors — Davis offers lessons for how the whole transplant system could make better use of organs, Kaufman said.“They’re doing everything right,” he said.