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Multiple Transplant Center Waitlists: What Patients Should Consider

Among treatment options for end stage renal disease (ESRD), kidney transplantation is considered the optimal treatment for most patients, with the best outcomes—in terms of the replacement of kidney function and overall quality of life—associated with transplantation performed early in the course of renal replacement therapy. When a patient chooses transplantation, it’s natural to want to help improve the odds of obtaining an organ—and in a timely manner—by gaining placement on multiple center waitlists. Here’s a high-level view of the placement process as well as the considerations and criteria patients should consider when comparing center options.

Transplant center waitlist process

The general process for patients wishing to obtain placement on a center’s transplant waitlist involves an initial appointment with the center and completion of the center’s evaluation process—which is then reviewed by a multidisciplinary team for placement determination. This evaluation process can take months up to 1 year to complete.

The specific center a patient visits may be determined by physician referral, the patient’s payer network or the patient’s own preference. A patient can go anywhere in the United States depending on his or her ability to get there. The evaluation process involves a series of tests that determine if the patient is healthy enough to tolerate surgery, has any medical conditions that would impact transplant success and if the patient is likely to comply with post-transplant care regimens. Once the evaluation process is completed, the center’s team will aggregate the results and determine candidacy.

Considerations for patients seeking multi-center candidacy

Patients should consider several factors when looking at various transplant centers:

Practical considerations. A center in a different area (such as a rural location) may increase the odds of receiving an organ; however, this has to be balanced against the inconveniences of travel (for evaluation and follow-up), dialysis treatment needs/adjustments, travel costs, and overall time away from home.

Personal considerations. Patients should also consider personal factors, including:

  • How close will the patient’s family, friends, and/or support system be?
  • Does the patient have a preference for a certain part of the country?
  • What type of rapport and confidence level does the patient have with the center’s transplant team?

Center considerations. Finally, patients may want to research or interview staff to learn about the center, including:

  • Number of kidney transplants performed annually
  • Kidney transplant survival rates
  • Commitment to keeping up with transplant innovations
  • Paired-donation or donation-chain programs
  • Additional services, such as travel arrangement assistance, recovery housing, support groups and referrals to other resources
  • Statistics in the Scientific Registry of Transplant Recipients

Helping patients understand the transplant center waitlist process and educating them on important considerations is part of providing patient-centered care—empowering patients to make the best decisions for their own situation, preferences and health goals. When patients feel empowered, their engagement level increases, resulting in greater patient satisfaction and better health outcomes.

Bryan Becker, MD, MMM, FACP, CPE

Bryan Becker, MD, MMM, FACP, CPE

Bryan N. Becker, MD, is chief medical officer of DaVita Integrated Care and has nearly 20 years of physician executive experience. He received his AB in English at Dartmouth College and MD from the University of Kansas, and, after training at Duke and Vanderbilt, he led the nephrology group at the University of Wisconsin and developed a new kidney care venture called Wisconsin Dialysis, Inc. He also served as CEO at the University of Illinois Hospital and Clinics and president of the National Kidney Foundation. Before joining DaVita Kidney Care, Dr. Becker served as President of the University of Chicago Medicine (UCM) Care Network, a more than 1,000 physician clinical integration organization, and Vice President, Clinical Integration and Associate Dean, Clinical Affairs at UCM. Twitter: @bnbeckermd