Elective cyclosporine withdrawal after renal transplantation: a meta-analysis

Article Abstract:

Elective withdrawal of cyclosporine in patients who have undergone kidney transplants appears to increase the numbers of acute rejection, but without compromising graft or patient survival. Cyclosporine is an immunosuppressive drug used to promote graft survival following transplants, but its long-term use is expensive and may be both toxic and unnecessary. In a two-part study, patients who withdrew from treatment were compared with patients who continued treatment and with patients who had never taken cyclosporine. In part one, there was a higher incidence of acute rejection in patients following withdrawal than in patients who continued treatment, but there were no significant differences in graft loss or patient deaths. In part two, there was no difference in graft loss between patients who had never taken cyclosporine and patients who withdrew from treatment. Results from three randomized studies, however, indicate temporary use of cyclosporine improves graft survival.

Prevention, Drug therapy, Graft rejection, Dosage and administration, Cyclosporine, Cyclosporins

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Organ procurement expenditures and the role of financial incentives

Article Abstract:

Financial incentives may increase the availability of donor organs but at the same time threaten the relative cost-effectiveness of transplantation. Currently, organ procurement is based on altruism and selling organs is strictly prohibited under the National Organ Transplant Act. Unfortunately, the number of people on waiting lists for donated organs continues to increase while the supply of organs lags far behind. Between 1983 and 1991, the cost of procuring organs rose dramatically. The average procurement charge rose 12.9% for kidneys, 64.1% for hearts and 61.8% for livers. The percentage of total transplantation costs attributed to organ acquisition is 31% for kidney transplants, 14% for heart transplants and 11% for liver transplants. While a recent survey found that 65% of adults would be in favor of giving some sort of financial incentive to organ donors or their families, any form of financial incentive would increase the total cost of transplantation.

Analysis, Sale of organs, tissues, etc., Tissue selling (Medicine)

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Payment for Immunosuppression After Organ Transplantation

Article Abstract:

Medicare should pay for the cost of immunosuppressive drugs for all organ transplant recipients who cannot afford to pay for them. All organ transplant recipients must take drugs to suppress their immune system so their body won't reject the transplant. However, they must take these drugs for the rest of their lives. Currently, Medicare coverage of immunosuppressive medications ends after three years. Evidence suggests that at least some transplants have failed because the patient cannot afford to pay for the drugs.

Finance, Medical care, Immunosuppressive agents, Medicare

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