Opinion

Kidney transplants: Correct the flaw in the sytem

A surgical team performing an operation in a California hospital.(Photo: Hernndorff, via Shutterstock)

In 1999, my kidneys failed and I started dialysis. But like all kidney patients, I wanted a kidney transplant instead of going to dialysis clinics for the rest of my life. Dialysis is an exhausting process that leaves you at risk of bleeding out or having your blood pressure drop dangerously low. So after seven years of waiting, I finally received a kidney transplant in 2006. That same kidney has kept me alive, and I am grateful I have never had to go back to dialysis.

Part of the reason I have stayed healthy is because my continuous health insurance pays for the medication to prevent my body from rejecting the transplanted kidney.

But there is a flaw in our system that could prevent kidney transplant recipients from getting this kind of care. SB 1156, a bill currently awaiting Gov. Jerry Brown’s signature, should be signed into law to correct that flaw and protect patients.

Since my kidney transplant 12 years ago, my health insurance has covered the anti-rejection medication that costs up to $15,000 a yea

Not every patient with kidney failure is as fortunate as me. Although some non-profit groups are stepping in to help patients pay for their dialysis treatment, other groups are putting patients in jeopardy. One such “charity” is the American Kidney Fund, which received $242 million in funding from the two largest dialysis corporations in 2016. It steers patients into private health insurance plans with a strings-attached promise: it will pay patients’ premiums but only until they stop being a source of income – such as when patients receive a kidney transplant.

The American Kidney Fund typically stops paying patients’ health insurance premiums in as little as four months after patients receive a kidney transplant, when patients are still at high risk of rejecting the transplant.

As a kidney transplant recipient, I know my body is at risk of rejecting the organ in the ensuing months and years, and having continuous health coverage during this time is crucial. The last thing kidney transplant patients should face is having the payments for their health premiums stopped too soon after they receive their transplant.

SB 1156 will prevent this from happening by requiring groups that are paying for patient premiums to cover their health insurance for 12 months, even if the patient stops dialysis that financially benefits the provider.

This reasonable fix will put dialysis patients ahead of profits and save lives. Since my kidney transplant 12 years ago, my health insurance has covered the anti-rejection medication that costs up to $15,000 a year. In fact, of the patients who receive kidney transplants, more than one out of every four transplants will fail in the first five years, and 16 percent of those transplant recipients die within five years.

This is why it’s so critical that a patient’s care is not disrupted during their course of treatment.

For dialysis patients who get their health coverage through the American Kidney Fund, they have the right to be told that there are other coverage options available to them. SB 1156 will require this disclosure and if a patient chooses, may still receive premium assistance from a charitable organization.

The Centers for Medicare and Medicaid Services has found that the groups which are steering kidney patients into private coverage can actually interfere with their transplant readiness and also expose them to financial harm.

SB 1156 removes the financial incentive for dialysis corporations to game the system and prevents them from discontinuing payments for kidney patients’ health coverage too soon after a transplant.

That’s why I am asking Gov. Brown to sign SB 1156 into law. It will help to ensure more kidney patients benefit from the kind of care that I received and increase their chance of survival.

Ed’s Note: Shareef Ali is a kidney transplant recipient who lives in Sacramento.


  • David Moskowitz

    The elephant in the room in any discussion of kidney legislation is that dialysis should be obsolete by now, and everybody with kidney failure should have ready access to a cadaver kidney transplant. In 2002, I published a paper showing how to prevent 90% of adult dialysis (PubMed ID: 12396747). It has been ignored (see paper #9 at http://www.genomed.com/publications) by Medicare, the NKF, and all the professional associations I’ve asked over the past 22 years. Healthcare doesn’t want to eliminate dialysis; it’s far too lucrative. It’s a $200B/yr global industry affecting ppl of color 3-5X more than whites. It’s time to make California dialysis-free. It can be done in as little as 5 years.

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