UAB experts weigh in on Trump’s kidney disease executive order

This executive order could mean positive change in Alabama, which has the third-highest death rate from kidney diseases in the nation.

RS24777 Agarwal Anupam scrAnupam Agarwal, M.D., School of MedicineOn Wednesday, July 10, President Donald Trump signed an executive order signaling new measures that could overhaul treatment for kidney diseases, donations and kidney transplants.

As one of the premier transplant centers in the Southeast, University of Alabama at Birmingham Hospital treats a high volume of patients with kidney diseases. Experts from UAB and Legacy of Hope, formerly known as the Alabama Organ Center, believe this executive order could mean positive change in Alabama, which has the third-highest death rate from kidney diseases in the nation, according to the Centers for Disease Control and Prevention.

Anupam Agarwal, M.D., executive vice dean for the UAB School of Medicine and the Marie S. Ingalls Endowed Chair in Nephrology Leadership, says this executive order should be seen as positive for all parties involved because of the attention it brings to kidney diseases, organ donation and organ shortages across the country. Agarwal, who also serves as the president-elect of the American Society of Nephrology, says that until this initiative, there had not been a program that incentivizes physician practices to prevent or delay patients with kidney diseases from going on dialysis.

“It provides financial incentives to physicians and nurses to find and utilize alternative treatments that can prevent and/or delay dialysis for their patients,” Agarwal said. “Health care providers will be rewarded if they are able to delay progression of kidney failure and reduce the number of patients needing dialysis and also early referral for kidney transplantation.”

Alabama also has one of the highest numbers of patients on dialysis per population in the nation.

One of the aims of the initiative is to have 80 percent of new Americans with end-stage kidney disease to be on a home dialysis modality or to receive a kidney transplant by 2025.  

The executive order has three main goals:

  • Reduce the number of Americans with end-stage kidney disease by increasing preventive care.
  • Incentivize the use of home dialysis or kidney transplants to cut down on the use of in-center dialysis treatments.
  • Increase the number of available organs for transplant by modernizing the organ recovery and transplantation system and encouraging the development of artificial and wearable kidneys — similar to wearable ventricular assist devices for heart failure patients.

Currently, more than 90,000 individuals in the country are waiting for a kidney transplant, yet fewer than 20,000 get a transplant each year. In 2019, there have been 138 kidney transplants in Alabama, 97 of those coming from deceased donors. Chris Meeks, director of Legacy of Hope, says the president’s comments and actions bring more attention to the need for registered organ donors.

“Legacy of Hope is working diligently to increase the number of organs available for transplant,” Meeks said. “As a result of our alliances with hospitals and the community, Legacy of Hope has provided more organs for transplant than ever before, 87 percent growth since 2012. There has been enormous growth in the number of organ donors, 68 percent since 2012.” 

Meeks adds that, currently, 38 percent of licensed drivers in Alabama are registered donors; but the need for more living donors remains great.

“Seventy percent of Alabama’s kidney transplant waiting list is African American,” Meeks said. “While the need is great in the African American community, the overall authorization rate for donation from registered and non-registered donors is 43 percent, significantly lower than the Caucasian authorization rate of 70 percent. The donor registry rates in the African American community are lower as well.”

UAB’s Comprehensive Transplant Institute (CTI) is one of the largest kidney transplant centers in the United States and has transplanted more African Americans than any other center in the country.

“We constantly seek to incorporate innovative strategies to help our patients achieve transplantation,” said Jayme Locke, M.D., CTI director and transplant surgeon

RS13489 Jayme Locke 33RT scr 1Jayme Locke, M.D., Comprehensive Transplant Institute directorUAB’s Living Donor Navigator Program provides advocacy and systems training to help transplant candidates identify living kidney donors, while the Incompatible Kidney Transplant Program combines desensitization and kidney paired donation to help incompatible living donor-recipient pairs achieve transplantation.

“This program in particular has helped mitigate gender and racial disparities in access to living donor kidney transplantation,” Locke said. “Kidney transplantation is associated with improved quality of life and increased longevity compared to dialysis, and kidney transplantation is considered the gold standard for treatment of end-stage kidney disease.”

For more than 50 years, UAB has cemented its place within the field of transplantation, looking to the future as it aims to advance knowledge through innovation and collaboration. 

“This executive order will require innovation in kidney care when it comes to dialysis,” Agarwal said. “We are still using the same dialysis technology that has been used for over 20 years. This has the potential to advance new avenues in dialysis and organ transplantation, and novel treatments for patients to improve their quality of life.”