Gill J. Presidential Address. Presented at: American Transplant Congress; June 4-8, 2022.
Disclosures: Gill does not report any relevant financial information.
The transplant community, HHS and procurement organizations must work together to increase the supply of organs for transplantation in the United States, according to remarks made at the American Transplant Congress.
“We need more than token gestures from our elected officials if we are to tackle the end-stage organ failure crisis that is killing 17 patients a day. [on the waitlist] in the United States,” said John Gill, MD, immediate past president of the American Society of Transplantation (AST), during his remarks.
Gill, a transplant physician and professor of medicine in the division of nephrology at the University of British Columbia in Vancouver, said efforts to improve organ donation start with the transplant community. He quoted a statement made by former AST President William Braun at a US Congressional hearing in 1990, which said, “The wonder of what transplantation was now is a superficial performance.
“What he was saying was that the magic of transplantation and this miracle of modern medicine had now faded from the public consciousness and were overwhelmed by other medical feats,” Gill said. “He thought it was important because we need to stay in touch with the public for our field to thrive. We need to rekindle the excitement and medical accomplishments” the specialty has achieved since the first kidney transplant performed in December 1954 by surgeons Joseph Murray and John P. Merrill on identical twins, Gill said.
The congress, being held in Boston, marks the 40th anniversary of the AST, which was founded in 1982 as the American Society of Transplant Physicians. The organization has grown from 295 members to 4,250 members, Gill said. AST publishes the American Journal of Transplantation.
Gill said the AST “has never been more important than it is now” in advancing organ transplant efforts. He highlighted the diversity of AST leadership, including five past presidents who were women, four presidents who were people of color, “and we even had four surgeons leading our company,” Gill said.
Likewise, the protection and fair treatment of the living donor is imperative, Gill said. In the United States, Medicare does not provide health care coverage to organ donors unless they qualify because of their age. “For [organ] donors to Medicare-insured beneficiaries, long-term health care costs are only covered if directly attributed to the donor’s surgery,” Gill said.
All health care costs for donors are covered in countries where health care is universal, he said. “Monitoring and treatment of conditions that may compromise residual kidney function should be covered,” he said. “Coverage should be determined by the relationship to the donor’s surgery and the potential for compromised kidney function post-donation” for the donor, he said.
He sees promise in a new law starting in January that will expand coverage of immunosuppressive drugs for transplant patients – “a 20-year effort”, he said.
Gill said metrics are important in organ donation, but “we need metrics that have value for the patient, not the payer.” What is more valuable is that the transplant community provide “patient-centered, culturally safe care to every potential deceased donor family, and if we did, we are confident that members of the public would respond in providing vital organs,” he said.
“The challenge isn’t really choosing the right outcome assessment — that’s the easy part,” Gill said, referring to organ transplant success. “The challenge is to align all of the actors who would be responsible for maximizing this multidimensional outcome with all of the care providers that touch our patients and for us to recognize that this is a large group. We need a system designed to achieve this.