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John Oliver targets dialysis, a procedure that’s exhausting, deadly, and very profitable

Dylan Matthews is a senior correspondent and head writer for Vox's Future Perfect section and has worked at Vox since 2014. He is particularly interested in global health and pandemic prevention, anti-poverty efforts, economic policy and theory, and conflicts about the right way to do philanthropy.

Last Week Tonight host John Oliver loves to spotlight somewhat obscure but very important policy questions that cable news (especially comedic cable news) typically ignores: things like local government “special districts” that spend $100 billion annually with minimal accountability, or abusive garment industry labor practices, or Puerto Rico’s debt crisis.

Sunday night, he turned to an issue near and dear to my heart as a kidney donor: the chronic kidney disease problem. Oliver notes just how brutal dialysis — or “a Brita filter for your blood” — is: “You're typically sitting in a chair, physically attached to a machine, for three four-hour sessions a week." And in the US, it's more brutal than it needs to be, as we have one of the highest dialysis death rates in the developed world.

While dialysis care is funded for everyone regardless of age or income through Medicare (as Oliver puts it, we have “universal health care in this country for one organ in the body"), about 70 percent of out-patient dialysis clinics are owned by two for-profit companies: Fresenius Medical Care and DaVita.

Oliver focuses on DaVita, which is run by an eccentric businessman named Kent Thiry with a bizarre obsession with the Leonardo DiCaprio version of The Man with the Iron Mask. His company has been accused of all manner of wrongdoing, including throwing out drugs so that it could bill Medicare more, cutting off dialysis prematurely to get additional patients in quicker, “not disinfecting properly” between patients, and offering doctors payoffs to refer patients.

It would be far better for DaVita and Fresenius’s patients to get kidney transplants, which extends your lifespan by about 10 years on average, relative to remaining on dialysis, while avoiding exhausting, time-consuming treatment that makes holding down a job or traveling extremely difficult. But as Oliver notes, many dialysis centers fail to give patients information on transplantation, or actively discourage them from getting on the kidney waitlist. Partly as a result, about 40 percent of people eligible for a kidney transplant aren’t on the waiting list for one.

Oliver sent four staffers to four of DaVita's "Kidney Smart" classes, directed at pre-dialysis patients, and heard staffers downplaying the benefits of transplants. One meeting, which Oliver's team recorded, featured a DaVita educator saying, "You don't have to do a transplant. I've had patients that decided, 'No, I don't want that.' … I know I say this and it sounds crazy, but I've had patients that said, 'No I don't think I want to leave, so I won't take the transplant.' And they stayed. This is their community." The implication is that you should turn down a lifesaving transplant because you like hanging out in a dialysis center. That’s ridiculous, and dangerous.

If you’re outraged by that, as you should be, Oliver encourages you to think about signing up as a living kidney donor; you can start by filling out this form. I gave my kidney to a stranger last August, and it’s the most meaningful thing I’ve done in my life. I heartily recommend it to anyone considering it.

If that’s a step too far, you can also sign up as a deceased donor, and tell your family that you want your organs donated upon your death. Deceased donor organs are less helpful to recipients than living donor organs, but they’re definitely better than life on dialysis.

You can also push for legal changes that can fix some of these problems. The New York State Living Donor Support Act is currently being considered in the New York state legislature. It's sponsored by the chairs of the New York State Assembly and State Senate health committees, backed by the speaker of the Assembly and Majority Leader in the Senate, and has support from leading hospitals like Columbia University Medical Center, the SEIU 1199 union which organizes many nurses, and advocacy groups like Waitlist Zero.

The bill would remove disincentives to donation by paying living kidney donors for lost wages, travel, child care, and caretaker expenses. Crucially, it would also mandate the nephrologists give transplant education materials designed by experts to all patients, to ensure that dialysis patients in places like DaVita know that transplant is an option.

Waitlist Zero estimates that the bill would cost only $3 million a year, and increase live donor transplants by about 20 percent, or about 100 more per year. That's a thousand or more new years of life offered to kidney patients from one piece of legislation.

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