Post & Courier: Medicare cut puts SC transplants at risk: Vital monitoring tool lost
By Zharia Jeffries zjeffries@postandcourier.com
Earlier this month, U.S. state representatives and senators rallied on Capitol Hill advocating for the reinstatement of Medicare coverage for vital blood tests crucial in the post-transplant journey.
“I initially had planned to be a part of that group until I got sick,” said Margaret Gamble, a former South Carolina state representative.
Gamble is a two-time kidney transplant patient, and tests like AlloSure, a noninvasive blood test used to detect potential organ rejection, added a layer of reassurance to her post-transplant routine. AlloSure looks for certain biomarkers in a patient’s blood that could be early signs of rejection
The test was made available to patients via Medicare in 2017, but in March 2023, Medicare decided to limit coverage to patients who met certain criteria, turning the test from a surveillance tool into a diagnostic test more likely to find patients who were already starting to having problems.
Gamble’s journey began in 2010 when she was diagnosed with Stage 4 kidney disease after a lifetime of grappling with kidney stones. Her sister became her lifeline with a kidney transplant in 2012. However, rejection struck that same year, plunging Gamble into a year of dialysis. In 2013, a second transplant brought renewed hope, and for a decade, life flowed smoothly.
“Having lost my first kidney, I’ve been really focused on doing everything I can to keep this second kidney and to learn as much about how to keep the kidney functioning,” Gamble said.
For her, these changes came at a critical time. Her doctors sought surveillance tests after her battle with COVID-19 in January 2022, but she remained ineligible for four months. Only a recent illness allowed her access to the AlloSure test under surveillance measures. The window of early detection was narrowed, and bureaucratic hurdles multiplied.
In addition to following a very strict low sodium and low-oxalate diet, Gamble undergoes routine lab work, which included regular AlloSure tests up until January 2022. Gamble was diagnosed with COVID-19 in late 2021.
“Why should a policy, in place for more than six years, be altered?,” Gamble said, questioning the seemingly inexplicable motives behind the sudden change.
Dr. Zachary Sutton, a kidney transplant expert from the Medical University of South Carolina, paints a vivid picture of the ramifications of this policy shift. He speaks of the AlloSure test as a beacon that could catch rejection sooner, understand a patient’s risk at any stage and revolutionize long-term transplant care. However, the new Medicare billing rules have turned this beacon into a flashlight with specific barriers.
“To have new tests available that have the ability to not only screen but follow these patients long-term to monitor their risk of rejection better than the older test was the next big thing in transplant care,” Sutton told The Post and Courier.
And with an increasing number of people in South Carolina requiring dialysis treatment and a record number of kidney transplants done, the need for such a screening tool is evident, according to Sutton.
“If we’ve got all this incentive, all this drive to transplant more patients, why would you take away a tool that is beneficial in the care of not only the patients we have, but the record number of patients that we’re going to continue to have moving forward,” Sutton said. “That just doesn’t make sense.”
Many leading voices have spoken out on this issue since March. And according to a recent press release from Honor the Gift, an advocacy coalition for transplant patients, national transplant medical associations like the American Society of Transplant Surgeons, the American Society of Transplantation and the International Society for Heart and Lung Transplantation have all written letters in support of this issue.
For more information on these issues, visit honorthegift.org/post-transplant-diagnostic-testing