BMI, Obesity, and Kidney Transplants

Dr. Heather Gardiner from Temple University discussed her research on BMI as being a factor in a patient’s eligibility for a kidney transplant. She explained how kidney disease affects more than 200,000 people per year. With kidney disease, patients are administered dialysis. Yet, with this treatment, they can’t travel, they are in pain and often fall into a state of depression. Therefore, surgery to help them get off of dialysis is very ideal. However, patients are tested on BMI and those over a threshold determined by the clinic cannot get the surgery.

Dr. Gardiner’s research stemmed from this difficulty that patients experience due to being turned away from surgery. She discovered that BMI was not a true indicator of obesity however it continues to be used to indicate transplant abilities. Additionally, there is an obesity paradox that having a little extra weight can help to cope with dialysis yet they are told to lose weight for a transplant. It does not follow. Among transplant candidates with obesity defined by BMI, just half ever achieve active status and another 15% die before reaching active status. Therefore, Dr. Gardiner had some recommendations. Her research recommended that transplant facilities need to assess the provider or program bias and reconsider using BMI during evaluation for surgery. Of the policies of 19 transplant centers, only eight had documented plans to help weight loss. Her recommended alternatives included alternative ways to accurately test for obesity. This is where I began to question it. It seemed that her alternatives were costly and that weight was a true indicator of how the surgery was going to be successful or not. Therefore, removing BMI, while the reasons follow, it does not follow that transplant centers will remove BMI from their programs and replace it with ways that are more time consuming and costly to do. Also, she did not know a lot of the science behind the transplants that frustrated me when answers I would have liked to know could not be answered. She was a very captivating speaker and I would like to know more of how her research will play out.

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