Kidney paired donation: a payer perspective.

Kidney transplantation is the most cost-effective and clinically effective form of renal replacement therapy. Due to long wait times for deceased donors, kidney transplantation is not available to many patients with incompatible living donors. Increased access to kidney transplantation is a shared goal that can be achieved through kidney paired donation (KPD). A single, national system of KPD administered to a set of clinical and ethical standards determined by a consensus of stakeholders including recipients, donors, providers, payers and the United States federal government will provide the best opportunity to offer kidney transplantation to the most people and particularly to those currently unlikely to receive a transplant. We propose that this system will use uniform tissue typing algorithms and a computerized donor and recipient matching program using a national pool of willing donors. The proposed system can be managed best through a single administrative structure that takes advantage of uniform donor evaluation and management with a standardized organ acquisition charge that recognizes that the current lack of standardization contributes to delays in transplantation and payment to programs. This program will use the existing Organ Procurement Organization infrastructure to manage the logistics of organ acquisition, transportation and billing.

Helicobacter pylori infection. The importance of eradication in patients with gastric disease.

Discovery of Helicobacter pylori infection in patients with peptic ulcer disease has completely transformed the approach to the disease. Implications of this discovery for healthcare in general and for medical economics are only now being appreciated. Noninvasive and invasive methods of establishing the presence of infection are currently available, and clinical introduction of the recently approved urea breath test in the near future will add another method for documenting both active infection and successful eradication. Patients with initial presentation or recurrence of gastric or duodenal ulcer disease and those with previous disease who are receiving maintenance therapy should be treated for H pylori infection. Treatment regimens, which consist of combinations of antibiotics, bismuth salts, and proton pump inhibitors, can result in cure rates of 90%, with prevention of recurrence. Understanding of the infection continues to grow rapidly, and current recommendations regarding diagnosis and treatment will evolve as new methods are developed.