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President Trump signs executive order expanding kidney treatment options

President Trump signs executive order expanding kidney treatment options

WINNG: Kidney dialysis stocks soar.

In a wonderful move that can help up to 30 million Americans, President Donald Trump signed an executive order this week that permits an overhaul of the way kidney disease is treated within this country.

The president’s move would lead to sweeping changes in treatment as well as prevention, including improving access to dialysis treatment in the home and enabling people with failing kidneys to have opportunities sooner to get a transplant.

“This is a first, second and third step, it’s more than just a first step,” said Trump just before signing the executive order. “We’re going to come up with solutions over a period of five years and 10 years, that I think most people won’t believe.”

Some of the initiatives will require new government regulations.

And because a severe organ shortage complicates the call for more transplants, the administration also aims to ease financial hardships for living donors, said the officials, who spoke on the condition of anonymity ahead of the announcement.

Approximately 43,000 people who need a kidney transplant die each year due to a shortage of kidneys. Most people with kidney disease currently survive from dialysis, an expensive and complicated procedure that involves being connected to a blood-cleaning machine at a hospital for hours. Furthermore, 2 dialysis firms handle the majority of the cases.

The rules will allow for the development of more treatment option that are more convenient and affordable.

The new proposal has three parts that could help patients with finances, access to organs for donation, and assistance with at-home dialysis:

First, it would provide federal funding to make it financially easier for living donors to donate — by covering travel costs, lost wages, and child care expenses during surgery and recovery — thus increasing living donations.

By lessening the financial burden through federal funding for living donors, officials hope more people will donate and help decrease the transplant waiting list.

Second, it would improve processes with organ procurement organizations (OPOs) so that thousands of organs — including kidneys, intestines, and livers — don’t go to waste each year.

Lastly, it would help patients receive dialysis at home rather than in the large medical centers they must go to today.

The order is one of the biggest initiatives focused on kidney health in decades.

Kidney dialysis firms stocks soared after the signing, and competition seems to already be gearing up.

The dialysis clinic giants now treat about 13% of their patients at home, and say they are moving to expand that business. Davita has said it wants to double its home dialysis business, so that at least 25% of its patients receive home treatment by 2025.

Rival Fresenius has said it plans to double its home dialysis business by 2022. Toward that end, Fresenius completed its acquisition of dialysis device maker NxStage for $2 billion this year.

Even before the administration’s announcement, a number of competitors have already set their sights on growth in the home dialysis market.

CVS Health launched a kidney care initiative this spring focused on prevention and management of chronic kidney disease, and the company says it is working on getting FDA clearance for its own home hemodialysis machine.

Read the full EO here:

By the authority vested in me as President by the Constitution and the laws of the United States of America, it is hereby ordered as follows:

Section 1. Purpose. My Administration is dedicated to advancing American kidney health. The state of care for patients with chronic kidney disease and end-stage renal disease (ESRD) is unacceptable: too many at-risk patients progress to late-stage kidney failure; the mortality rate is too high; current treatment options are expensive and do not produce an acceptable quality of life; and there are not enough kidneys donated to meet the current demand for transplants.

Kidney disease was the ninth-leading cause of death in the United States in 2017. Approximately 37 million Americans have chronic kidney disease and more than 726,000 have ESRD. More than 100,000 Americans begin dialysis each year to treat ESRD. Twenty percent die within a year; fifty percent die within 5 years. Currently, nearly 100,000 Americans are on the waiting list to receive a kidney transplant.

Sec. 2. Policy. It is the policy of the United States to:

(a) prevent kidney failure whenever possible through better diagnosis, treatment, and incentives for preventive care;

(b) increase patient choice through affordable alternative treatments for ESRD by encouraging higher value care, educating patients on treatment alternatives, and encouraging the development of artificial kidneys; and

(c) increase access to kidney transplants by modernizing the organ recovery and transplantation systems and updating outmoded and counterproductive regulations.

Sec. 3. Announcing an Awareness Initiative on Kidney and Related Diseases. Within 120 days of the date of this order, the Secretary of Health and Human Services (Secretary) shall launch an awareness initiative at the Department of Health and Human Services (Department) to aid the Secretary’s efforts to educate patients and support programs that promote kidney disease awareness. The initiative shall develop proposals for the Secretary to support research regarding preventing, treating, and slowing progression of kidney disease; to improve kidney transplantation; and to share information with patients and providers to enhance awareness of the causes and consequences of kidney disease.

Sec. 4. Payment Model to Identify and Treat At-Risk Populations Earlier in Disease Development. Within 30 days of the date of this order, the Secretary shall select a payment model to test innovations in compensation for providers of kidney care services based on kidney patient cost and quality outcomes. The model should broaden the range of care and Medicare payment options available to potential participants with a focus on delaying or preventing the onset of kidney failure, preventing unnecessary hospitalizations, and increasing the rate of transplants. It should aim at achieving these outcomes by creating incentives to provide care for Medicare beneficiaries who have advanced stages of kidney disease but who are not yet on dialysis. The selected model shall include options for flexible advance payments for nephrologists to better support their management and coordination of care for patients with kidney disease.

Sec. 5. Payment Model to Increase Home Dialysis and Kidney Transplants. Within 30 days of the date of this order, the Secretary shall select a payment model to evaluate the effects of creating payment incentives for greater use of home dialysis and kidney transplants for Medicare beneficiaries on dialysis. The model should adjust payments based on the percentage of a participating provider’s attributed patients who either are on home dialysis or have received a kidney transplant and should include a learning system to help participants improve performance. Greater rates of home dialysis and transplantation will improve quality of life and care for patients who require dialysis and may eliminate the need for dialysis altogether for many patients.

Sec. 6. Encouraging the Development of an Artificial Kidney. Within 120 days of the date of this order, in order to increase breakthrough technologies to provide patients suffering from kidney disease with better options for care than those that are currently available, the Secretary shall:

(a) announce that the Department will consider requests for premarket approval of wearable or implantable artificial kidneys in order to encourage their development and to enhance cooperation between developers and the Food and Drug Administration; and

(b) produce a strategy for encouraging innovation in new therapies through the Kidney Innovation Accelerator (KidneyX), a public-private partnership between the Department and the American Society of Nephrology.

Sec. 7. Increasing Utilization of Available
Organs. (a) Within 90 days of the date of this order, the Secretary shall propose a regulation to enhance the procurement and utilization of organs available through deceased donation by revising Organ Procurement Organization (OPO) rules and evaluation metrics to establish more transparent, reliable, and enforceable objective metrics for evaluating an OPO’s performance.

(b) Within 180 days of the date of this order, the Secretary shall streamline and expedite the process of kidney matching and delivery to reduce the discard rate. Removing process inefficiencies in matching and delivery that result in delayed acceptance by transplant centers will reduce the detrimental effects on organ quality of prolonged time with reduced or cut-off blood supply.

Sec. 8. Supporting Living Organ Donors. Within 90 days of the date of this order, the Secretary shall propose a regulation to remove financial barriers to living organ donation. The regulation should expand the definition of allowable costs that can be reimbursed under the Reimbursement of Travel and Subsistence Expenses Incurred Toward Living Organ Donation program, raise the limit on the income of donors eligible for reimbursement under the program, allow reimbursement for lost-wage expenses, and provide for reimbursement of child-care and elder-care expenses.

Sec. 9. General Provisions. (a) Nothing in this order shall be construed to impair or otherwise affect:

(i) authority granted by law to an executive department or agency, or the head thereof; or

(ii) the functions of the Director of the Office of Management and Budget relating to budgetary, administrative, or legislative proposals.

(b) This order shall be implemented consistent with applicable law and subject to the availability of appropriations.

(c) This order is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person.


July 10, 2019.


Donations tax deductible
to the full extent allowed by law.


I thought we could 3-d print kidneys now. I know we can print livers. Why aren’t we seeing more adoption of such manufactured organs?

JusticeDelivered | July 12, 2019 at 6:27 pm

What will be really dramatic is when nanotech gets to the point that we are enhancing the immune system. That is perhaps 50 to a 100 years.

ScottTheEngineer | July 12, 2019 at 7:49 pm

Make organ donor the default on Drivers license with an opt out option. Problem solved.
Please send checks for whatever donation amount you feel is appropriate to me.

    The ideal solution is to clone kidneys. The problem is that transplants
    can be rejected and clones significantly reduce that popularity.

    At this point in time you want people on dialysis ASAP so that when clones are actually possible they can get a clone. If they have already
    had a transplant, then a clone won’t be that much of an improvement.

I don’t see the problem. Free trade!. You can just do transplant tourism, fly to China when convenient, and they will slaughter some Falun Gong or other political prisoner – with millions one will be a match, and you will get one or two kidneys!

This is a very positive development, but I wonder if there has been some significant technical advances in the last 3 years that prompted this Executive action. Seems like this could have been a non partisan legislative action. Not tried? Don’t want to give DJT a legislative victory? Inquiring minds want to know.

Doesn’t fix the real problem: the prohibition on selling organs. It is, apparently, a morally superior result if a rich person dies because that spares a poor/middle-class person from feeling envy. Never mind that the poor/middle-class person was never going to get that organ, whether sales are allowed or not.