For the last quarter century, my 75-year-old mom has lived with progressive kidney disease and its accomplices: high blood pressure, long lists of medications and, as her kidney function declined, injections and transfusions, swelling and itchiness, extreme fatigue, a restricted diet, and the knowledge that one day, her kidneys would stop working. This year she was approved for a living donor transplant and my dad was approved as a match, and this summer they underwent simultaneous surgeries that we hope and pray will provide her with a functioning kidney for the rest of her life.
Kidneys are an often underappreciated workhorse. Each is about the size of a fist; and together they filter our blood every 30 minutes. They remove waste, toxins, and excess fluid, and help control blood pressure and maintain bone health. When they stop working, the consequences are dire.
More than 35 million U.S. adults – 1 in 7 – have kidney disease, and over 50,000 die of it each year, more than breast cancer or prostate cancer. It is the eighth leading cause of death in the United States. The gold standard treatment for most patients is a donated organ, which allows most recipients to go on to live relatively normal lives. The only other treatment is dialysis, which mechanically filters your blood outside of your body several times a week, for multiple hours at a time. It is physically and emotionally exhausting, and an estimated 15-20% of patients die within one year of starting the treatment. After five years of hemodialysis, only about 35% are still alive, compared with 80% for transplants.
Dialysis costs almost $100,000 per patient per year, and in 2022 the federal government spent over $45 billion on patients undergoing dialysis, a staggering 5% of the total Medicare budget. In contrast, transplants incur a one-time surgical cost of $130,000 to $165,000, followed by annual immunosuppressant drug costs of around $25,000. Shifting more patients from dialysis to transplants would save taxpayers billions of dollars per year. But nearly 90,000 people remain on kidney transplant waiting lists. A new patient is added to the organ transplant waiting list every eight minutes, and each day 13 people die waiting for a transplant.
Six years ago, President Trump was moved to do something. First Lady Melania Trump had been treated for a benign kidney condition, and HHS Secretary Alex Azar’s father had suffered from end-stage kidney disease. In July 2019, Trump signed an executive order that made kidney disease a national priority and aimed to improve treatments while reducing costs. It called for better awareness and education, modernization of organ recovery and transplantation systems, incentives to encourage living organ donation, and innovation in artificial kidney development and early detection and treatment. Kevin Longino, CEO of the National Kidney Foundation and himself a transplant patient, declared a “renaissance” for kidney care.
Bipartisan steps followed. In 2023, Congress unanimously passed the Securing U.S. Organ Procurement and Transplantation Network Act to help modernize the organ transplant system. In September it replaced the monopoly the private nonprofit United Network for Organ Sharing had held since the 1980s as the sole manager of the network with competitive contracts.
However, despite Robert F. Kennedy Jr.’s promises to “Make America Healthy Again” by focusing on chronic disease prevention, Trump’s new administration has been taking steps that threaten this progress.
The seemingly indiscriminate recent cuts to the Health and Human Services Department included significant numbers of employees working to enact the critical imperatives of Trump’s earlier executive order. Cuts to Medicaid and Affordable Care Act coverage in the Big Beautiful Bill Act will not only compromise the health and safety of kidney patients, but will also cost all taxpayers more in the long run. And, perhaps most ominously, the administration has proposed slashing HHS’s 2026 budget by over 25%, including a 40% cut to the National Institutes of Health, which over 500 public health organizations and non-profits have warned would “effectively devastate our nation’s research, scientific, and public health infrastructure.”
Since World War II, the U.S. government has invested more than anyone else in the world in scientific research. These investments have fueled progress in areas including organ transplantation, cancer research, treatments for heart disease and opiod addiction; supported the development of over 95% of all new drugs; and provided the American economy with a staggeringly high return of 150% to 300% on its investment. In the transplant world, it was federally funded research that enabled economists David Gale and Alvin Roth to win the Nobel Prize for their work to improve the stability of matchmaking, which formed the very basis for our current living organ donor match systems .
As Congress considers the 2026 budget it has an opportunity to secure the health of Americans, save taxpayers money, and preserve America’s status as a global leader. (China has been increasing its investment and is on track to take the lead in scientific spending by 2027 – or sooner, if these cuts go through). Providing HHS’s Organ Transplant program with just $67 million a year will allow for the improvements promised in the Securing OPTN Act. Protecting the NIH’s budget and ensuring that the National Institute of Diabetes and Digestive and Kidney Diseases is proportionally funded will continue the tremendous progress of the last few decades.
My parents are home from the hospital and continuing their post-transplant recovery – the beginning of what we hope is their next and brighter chapter. We are deeply grateful and look forward to a day when more Americans have the same opportunity. Congress has the opportunity to make that a reality.