September 13, 2019

Patients with renal failure who get dialysis at for-profit dialysis centers are less likely to receive a kidney transplant than patients who get dialysis at nonprofit centers, according to a study published Tuesday in JAMA.

Here are 5 key tactics to attract and retain transplant patients

For-profit dialysis patients are less likely to receive transplants

Kidney transplants are usually the best form of treatment for someone with end-stage renal disease, F. Perry Wilson, an assistant professor at Yale School of Medicine writes in a Medscape commentary. "It's cheaper than dialysis, less burdensome than dialysis, and associated with longer survival than dialysis," Wilson writes.

But some health experts have speculated that for-profit dialysis centers have an inventive to keep patients on dialysis, and therefore are less likely than nonprofit dialysis centers to get their patients on transplant lists.

To find out, a team of researchers analyzed data for nearly 1.5 million patients diagnosed with renal failure from 2000 to 2016 from the U.S. Renal Data System and the Dialysis Facility Compare. The patients were treated at about 6,500 dialysis centers, and 87% received care at for-profit facilities.

During that 17-year period, 8.2% of patients, or 121,680, were placed on a waiting list for a transplant from a deceased donor. Overall, 3.3%, or 49,290, received a transplant from a deceased donor and 1.6%, or 23,762, received a transplant from a living donor.

But the researchers found that patients at the for-profit facilities were 64% less likely to be placed on a transplant waiting list and 56% less likely to receive a transplant from a deceased or living donor.

Implications

The study authors noted that there are several factors that could cause the discrepancy between transplant and list rates at for-profit and nonprofit centers, such as patient education, patient willingness to get a transplant, tests to find a match, and case mix. Further, while the study findings do not show that for-profit dialysis centers intentionally delay patients from getting transplants, the authors noted that the trends held for patients who switched from for-profit centers to nonprofit, which suggests "there's more to the story," Wilson writes.

Rachel Patzer, a co-author of the study and an associate professor and director of health services research in the departments of surgery and medicine at Emory University School of Medicine, speculated that the system does not give for-profit centers any incentive to get patients on the transplant list. "The current system has no financial incentive for dialysis providers to educate, to spend time with, and to refer patients for transplant," Patzer said.

To bridge the transplant gap, Patzer said, "Incentives must be aligned so that regardless of whether it's a for-profit or a non-profit facility, the facility is incentivized to encourage those patients who are eligible for kidney transplant to pursue it" (Carroll, Reuters, 9/10; Wilson, Medscape, 9/11; Calandra, Managed Care Mag, 9/11).

Here are 5 key tactics to attract and retain transplant patients

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