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To kidney or not to kidney: Applying lessons learned from the simultaneous liver‐kidney transplant policy to simultaneous heart‐kidney transplantation
Author(s) -
Cheng Xingxing S.,
Khush Kiran K.,
Wiseman Alexander,
Teuteberg Jeffrey,
Tan Jane C.
Publication year - 2020
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13878
Subject(s) - medicine , economic shortage , intensive care medicine , kidney , kidney transplantation , transplantation , kidney transplant , heart transplantation , surgery , linguistics , philosophy , government (linguistics)
As the medical community is increasingly offering transplantation to patients with increasing comorbidity burdens, the number of simultaneous heart‐kidney (SHK) transplants is rising in the United States. How to determine eligibility for SHK transplant versus heart transplant alone is unknown. In this review, we situate this problem in the broader picture of organ shortage. We critically appraise available literature on outcomes in SHK versus heart transplant alone. We posit staged kidney‐after‐heart transplantation as a plausible alternative to SHK transplantation and review the pros and cons. Drawing lessons from the field of simultaneous liver‐kidney transplant, we argue for an analogous policy for SHK transplant with standardized minimal eligibility criteria and a modified Safety Net provision. The new policy will serve as a starting point for comparing simultaneous versus staged approaches and refining the medical eligibility criteria for SHK.