Most of us involved clinically are living with some degree of uncertainty regarding the implications of health care reform (ACA of 2010, Obamacare) on transplantation. Certainly, the exact impact remains unknown, with some positive and some negative effects likely. I would refer you to the excellent articles by Axelrod, Millman, and Abecassis (AJT 10: 2197-2207, 2010) for a flavor of what might be coming.

Thus far, in reviews of what should comprise the “essential health benefit” (EHB) to be included in all standard coverage, transplantation fares very well. Most, if not all,...

Last week's blog was written in anticipation of the SRTR-sponsored consensus conference on PSRs; I appreciate the responses received, including one from an old friend in a fairly prominent position who chose to reply personally. Was a very interesting meeting, with lots of open discussion and almost... but not quite... too much mathematics for me. Bottom line, SRTR, under its previous and current contractors, has produced a product unrivaled in American medicine. This was acknowledged by government, industry, and clinicians alike: our ability to collect and analyze accurate outcomes data...

Lack of dependable access to long-term immunosuppression is the Achilles’ Heel of American kidney transplantation. A legal remnant of now-disproven assumptions, the federal policy of discontinuing Medicare eligibility three years after a kidney transplant places thousands of recipients at risk each year, and is a major cause of graft failure. This policy also prevents countless potential recipients from even considering a transplant due to fears of financial ruin.

While AST and other groups have advocated for a rational end to this policy for years, an article published online...

I don't want to get too optimistic, but our Public Policy team in Washington has assembled strong, bipartisan support for the Immunosuppression bill now introduced in both the Senate and House. With each new look at the legislation, its cost is coming down, and with a Congress sorely in need of bipartisanship, this just may be our best chance ever at ensuring access to immunosuppression for the life of the allograft. Will passage of this bill make a difference for your patients? How much does cost influence your decisions about transplant candidacy? Selection of immunosuppressive regimen...