Evaluation of a Renal Transplant Program for Incarcerated ESRD Patients

Abstract

Renal transplantation (Tx) improves mortality and morbidity but is limited by availability of suitable organs. Clinical and economic impact of a Tx program for end-stage renal disease (ESRD) prisoners was evaluated. Wait list time and patient and organ survival rates were assessed. Twelve of the 104 ESRD prisoners at a prison dialysis unit were activated; 9 transplanted, 2 released active on the United Network for Organ Sharing list, and 1 died after listing. Kidneys from antibody-positive hepatitis C (HepC) donors were given to consenting HepC antibody-positive recipients. The average waiting period was 6.6 months for HepC-positive kidney recipients and 49.6 months for others. Compared with costs of continuing dialysis, Tx resulted in substantial savings. Patients with HepC experienced good graft and survival rates when given grafts from HepC donors, suggesting that transplantation is a viable, cost-effective option for the incarcerated patient with ESRD including those who have chronic HepC infection.

Interventions for the detection, monitoring, and management of chronic non-communicable diseases in the prison population: an international systematic review

“…Eight studies described both screening and management interventions [ 37 – 44 ]. Numerous chronic non-communicable conditions are represented in the included literature, encompassing diabetes ( n = 11) [ 45 , 49 – 51 , 53 , 55 , 56 , 59 , 60 , 63 , 67 ], gynaecological diseases ( n = 10) [ 26 , 27 , 29 – 33 , 38 , 43 , 70 ], cardiovascular disease (CVD) ( n = 6) [ 34 , 37 , 42 , 61 , 62 , 83 ], chronic kidney disease (CKD) ( n = 5) [ 35 , 52 , 66 , 72 , 73 ], dermatological conditions ( n = 4) [ 64 , 74 , 78 , 75 ], ophthalmological conditions ( n = 3) [ 57 , 58 , 77 ], respiratory illnesses ( n = 3) [ 48 , 54 , 68 ], oral cancer ( n = 1) [ 25 ], and colorectal cancer ( n = 1) [ 28 ]. Approximately one third of studies ( n = 22) covered several diseases and/or general long-term prisoner health [ 36 , 39 – 41 , 44 , 46 , 47 , 65 , 69 , 71 , 76 , 79 – 82 , 84 – 89 ].…”

Kidney Disease among People Who Are Incarcerated

“…There is also little peer-reviewed literature regarding dialysis and kidney transplantation during incarceration. Several peer-reviewed papers provide examples of correctional health systems that perform on-site dialysis or facilitate kidney transplantation (41)(42)(43), but these efforts are not analyzed or standardized at a national level. There are no published data on how many individuals are on the transplant list from the criminal justice setting or how many have already received kidney transplants while incarcerated.…”

“…The Erie County Medical Center protocol for obtaining kidney transplants for incarcerated individuals with kidney failure also included transplantation of kidneys from donors who were positive for hepatitis C virus to hepatitis C virus-positive recipients (45). Cost savings from the program if the allograft survived 2 years after transplant were estimated at $118,815 versus $131,256 if patients remained on dialysis, which would translate to an approximate overall cost reduction of $12,441 2 years post-transplant and $50,644 every year thereafter (42). Although limited in size and scope, these experiences highlight the feasibility of innovative programming to manage CKD, particularly in its advanced stages, as well as the informative role that cost-effectiveness analyses can have in assisting in population health decision making when considering costly interventions, such as dialysis and organ transplantation (65).…”

The structural conundrum of parolees and kidney transplantation

“…This inconsistency creates a particular challenge for parolees with ESRD who require Intermittent Hemodialysis (IHD), a life‐sustaining intervention that requires regular treatments and often has a host of complications and co‐morbidities (discussed below) Additionally, given that individuals do not have a protected right to regular IHD, but that EMTALA creates a right to stabilizing medical care in emergencies, the need for dialysis often results in expensive emergency room visits and avoidable hospitalizations 5 . Although some prisons evaluate inmates for kidney transplantation, this practice is not widespread, which means most parolees with ESRD are dependent on dialysis 6 …”

“…5 Although some prisons evaluate inmates for kidney transplantation, this practice is not widespread, which means most parolees with ESRD are dependent on dialysis. 6 Parolees face structural challenges in reentry to society, including unstable housing and difficulties securing employment, as well as obstacles to accessing necessary routine medical care. There is a reasonable inference that if parolees struggle to access necessary routine care, that is, dialysis, then a referral for evaluation by a Transplant Center may pose an insurmountable barrier.…”