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CMS aims to address kidney transplant issues with Enhanced Access to Organ Transplant initiative | iPharmaCenter

The Health and Human Services Department in the United States, administered by the Centers for Medicare & Medicaid Services (CMS), is introducing the Enhanced Access to Organ Transplants (EAOT) Initiative. The proposed initiative, managed by the CMS Innovation Center, aims to broaden access to kidney transplants for all individuals living with end-stage renal disease (ESRD), enhance the standard of care for those seeking kidney transplants, diminish disparities among recipients, and enhance the efficiency and capacity of participating transplant hospitals.

This initiative builds upon the Biden-Harris Administration's emphasis on enhancing the kidney transplant system and the collaborative endeavors between CMS and the Health Resources and Services Administration (HRSA) to boost organ donation, enhance clinical outcomes, system enhancement, quality measurement, transparency, and regulatory supervision.

Kidney transplantation stands as the optimal treatment for most individuals with ESRD, a condition arising when kidneys fail to function adequately. Recipients of kidney transplants generally experience better outcomes compared to those undergoing dialysis, with enhancements in their quality of life and liberation from prolonged and burdensome dialysis sessions. Nevertheless, organ scarcity, notably in kidney transplants, results in elevated patient mortality rates and a significant gap between demand and availability. Despite this shortage, approximately 30% of donor kidneys remain unused annually, underscoring deficiencies in procurement, distribution, and utilization. Prolonged waiting periods, averaging three to five years or longer, exacerbate patient suffering. With just over 28,000 kidney transplants conducted in 2023 and a waitlist of over 90,000 individuals during the same period, urgent measures are warranted to enhance the effectiveness and efficiency of the system.


Complex and disjointed care, coupled with disparities, contribute to the unequal distribution of this life-saving intervention. Access to organ transplantation not only varies by geographic location but also by factors such as race, ethnicity, disability status, and socioeconomic position. For instance, according to the Annual Data Report of the Scientific Registry of Transplant Recipients (SRTR), 32% of those on the waitlist were African American in 2021, yet only 13.5% of recipients of living donor transplants were African American. White individuals constituted 35.8% of the waitlist and 61.8% of living donor transplant recipients. The proposed Enhanced Access to Organ Transplants Initiative aims to tackle these challenges by enhancing overall care quality for ESRD patients and boosting the number of transplants performed.


CMS has recommended that the Enhanced Access to Organ Transplants Initiative become mandatory to ensure the attainment of a sufficient and representative national sample of participating kidney transplant hospitals, spanning diverse geographic locations and demonstrating proficiency in designing quality-focused care, provider performance, patient experience, and success in increasing transplant rates. CMS is primed and willing to collaborate with transplant hospitals to facilitate their improvement endeavors and will furnish them with additional resources and support. By collectively addressing the issue, we can move towards utilizing all available kidneys and ultimately enhancing the quality of life for hundreds of thousands of individuals and their families.


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