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Why Is The Kidney Transplant Rate So Low In Georgia?

Anna Frodesiak/Wikimedia Commons
A patient receives dialysis.

Waiting for a kidney transplant can be a long, difficult process. But a study performed in Georgia suggests that for some patients—particularly those from low-income neighborhoods—even getting that process started can be a challenge. 

Georgia has the nation’s lowest rates of kidney transplantation. A kidney transplant is the optimal treatment for a patient with end-stage renal disease (ESRD), so a team of researchers decided to look at referrals between dialysis centers and transplant centers in Georgia. According to their study, published this week in the Journal of the American Medical Association, fewer than one in four patients ages 18 to 69 were referred to transplant centers. 

Rates of referral ranged from zero to 75 percent. The centers with the lowest referral rates--less than 20 percent--were more likely to treat patients from high-poverty neighborhoods. 

Rachel Patzer, an author of the study and assistant professor of surgery at Emory University, says these referral rates seem low and may be contributing to the state’s low transplant rate. She and her team think referral rates should be closer to 100 percent. Recent researchshows that 80 to 90 percent of ESRD patients referred for transplant are eligible.

Doctors at dialysis centers are required by Medicare guidelines to educate their patients with ESRD on possible treatment options, including transplantation, within 60 days of the start of treatment. (Medicare will cover treatment for patients with ESRD regardless of age.) Referral to a transplant center is the next step. 

Though there are some conditions that might make someone ineligible for transplant, such as active cancer or infection, some of the facilities Patzer’s team studied didn’t refer a single patient to a dialysis center. “I don't think by chance that none of them are eligible for transplant,” she says. 

Even if some patients are ineligible, Patzer says it’s not the dialysis center’s role to decide that. “Really it's the transplant center that should be determining eligibility,” she says. 

The study doesn’t give explanations for the disparities in referral rates among Georgia’s 308 dialysis facilities, but Patzer and her colleagues think insurance coverage may be a significant barrier.

Many people in Georgia are uninsured. Even though Medicare would cover the cost of transplants, patients are considered to be cured three years after transplantation. If patients are still under 65 and without insurance at that point, Patzer says, they will have to pay out of pocket for their medication, which is necessary to keep their bodies from rejecting the new kidney. 

Patzer says patients may be making a financial calculation before they are even referred to a transplant center, and if more patients had insurance coverage, they might get on a transplant list even sooner. “If patients had good access to care prior to having end organ failure with their kidneys, they might have that conversation earlier with their primary care physician.”

Jake Harper can be reached at or 317-614-0482. Follow @jkhrpr.

Jake Harper is an investigative reporter for Side Effects Public Media, and he is a co-host of the Sick podcast. He can be reached at