An estimated 85,000 people in the U.S. await a kidney transplant, but every year, only 16,500 are transplanted in about 250 U.S. centers.
Segev says that with estimated costs of about $100,000 each, kidney transplantation is generally a moneymaker for hospitals that perform them, although lower quality organs have somewhat higher costs. Nevertheless, they are well worth the price-tag; each year of dialysis costs $60,000.
"By the second year, you save money," he says.
He emphasizes that today, only 5% of the 250 kidney transplant centers in the U.S., or about 10, transplanted more than two kidneys that were deemed of poorer quality in a year. And those centers did so because their patients were sicker, and because they were in areas of the country that don't get many kidneys for transplant.
Segev, who is on the UNOS Kidney Transplantation Committee, is confident that eventually a system similar to his will be adopted. But he acknowledges some effort to persuade transplant leaders to try it.
"One downside is logistical—it will have to be programmed into software. The second is political. Until people are convinced that this will not disenfranchise transplant centers, but will actually improve things for them, there will be some political debate," he says.
Additionally, some transplant centers may not want to be known as those centers that accept inferior kidneys and those more likely to have worse outcomes, because each center's transplant outcomes can be publicly compared on the Web.
"The more aggressive you are at accepting organs, the more likely you may be to come down on the scale," Segev says. "But for a hospital's patients, that's not the question. In some transplant centers, the organs are rarely available, and the patients run a higher risk of dying before they are."
"But I'm very optimistic this will be a reality in the near future. Everyone is always looking for ways to improve organ distribution," he says.