Table 3.

Recommendations of the NKF/KDOQI Conference on Early Transplantationa

Clinical RecommendationsFinancial Recommendations
Increase access to preemptive transplantation by promoting early patient education (CKD stage 3) regarding transplantation as an RRT option; promoting early referral (CKD stage 4) to a transplant center; promoting knowledge regarding LD kidney transplantation among patients with CKD and providersModify eligibility for Medicare ESRD to begin at late stage 4 or early stage 5 CKD (eGFR ≤15 to 20 ml/min)
Improve funding for support services in CKD clinics:

  • education regarding transplantation as modality of RRT;

  • accelerated processing time for Medicare enrollment;

  • social services

Improve efficiency of evaluation at transplant centers and of communication between transplant centers and referring physicians: staffing adequate to make 6 wk from referral to listing as the standardSupport Part B premium reimbursement by third parties (as with COBRA)
Increase percentage of LD transplants performed preemptively from 26 to 50%Promote measures to increase availability of kidneys for transplantation: provide adequate funding for the Organ Donation Recovery and Improvement Act; a national program to protect LD from financial disincentives and health risks associated with donor nephrectomy
Create benchmarks to measure performance:preemptive referral and transplantation rates for nephrologists and dialysis providers;evaluation time and preemptive transplant rates for transplant centersIncrease resource availability for:

  • posttransplantation care;

  • better reimbursement to nephrologists for posttransplantation care relative to long-term dialysis;

  • extension of Medicare entitlement from 36 mo to life of the allograft

Standardization of Medicaid coverage for kidney transplantation,including reimbursement of OAC
Higher reimbursement rates for dialysis units with higher case mix–adjusted transplant rates (cost neutral if lower rates for dialysis units with lower case mix–adjusted transplant rates)

  • ↵a eGFR, estimated GFR; NKF/KDOQI, National Kidney Foundation Kidney Disease Outcomes Quality Initiative.