Modern technology has made it possible to transplant many failed organs. We now transplant kidneys, livers, lungs, and even hearts. In 2022, more than 42,800 organ transplants were performed in the U.S., according to the United Network for Organ Sharing (UNOS). This is a record, an increase of 3.7 percent over the previous record in 2021.

Also, for the first year ever, more than 25,000 kidney transplants were performed in the United States. The total of 25,498 marked an increase of 3.4 percent over 2021. In addition, annual records were set for liver (9,528), heart (4,111) and lung (2,692) transplants.

“In a year that we commemorated one million transplants performed nationwide, we are glad to mark accelerated progress toward the next million,” said Jerry McCauley, M.D., M.P.H., president of the UNOS Board of Directors. ”We thank all the living and deceased organ donors, as well as the loved ones of deceased donors, who have provided a lifesaving gift. We also honor all the clinicians and professionals involved in organ donation and transplantation, who work tirelessly to make as many transplants happen as possible every day. We also should rededicate ourselves to meeting the continuing need,” added Dr. McCauley. “Many people still wait anxiously for a life-giving transplant. We must continue to improve in our capabilities to give them this vital opportunity by ensuring use of as many donated organs as possible.”

With all this progress in making organ transplants available to more and more Americans, you would think we would be doing everything possible to make these transplants a long-term success. Alas, this is not the case.

The Wall Street Journal editorial board says, “Government spending on healthcare often leads to rationed care owing to rising costs. Think of the waiting lists in Canada and new price controls on U.S. drugs. Another mistake is playing out in care for organ-transplant patients denied coverage for blood tests that detect problems.”

In March, MolDX, a program run by Medicare contractor Palmetto GBA to make coverage decisions on molecular lab tests, changed its guidance for when certain blood tests can be used. The tests, which use molecular technology to catch signs of organ rejection, are often ordered for patients who had kidney, heart or lung transplants. Under the contractor’s new policy, the tests can no longer be used as part of routine monitoring care for most patients.

The tests are expensive. Blood tests for kidney and heart rejection can cost $2,800-$3,200 each. To be most useful, they have been administered regularly to help doctors monitor the body’s response to a new organ. The tests pick up how failing organs shed donor DNA into the bloodstream, catching problems early. By the time a patient shows up with a fever, organ rejection is often advanced.

Stanford pediatric nephrologist Ken Sutha told WSJ that doctors must often walk a tightrope with transplant patients. The patients take immuno-suppressant drugs to prevent organ rejection. But if they get sick, their doctors must back off the suppressants to let their bodies fight the illness.

Blood tests are critical during that time for monitoring early signs of organ rejection. Dr. Sutha knows this as a practitioner and patient. He received a kidney donation from his father when he was 24, but lost it when the rejection wasn’t controlled. The alternative to the blood tests is an invasive biopsy that is also expensive and may be done too late to save the organ. Palmetto’s MolDX program answers to the federal Centers for Medicare and Medicaid Services (CMS).

This is a classic example of how government-controlled healthcare sacrifices the health of its beneficiaries in favor of saving government money. It is essentially rationing of care by another name. Unless you are wealthy, you cannot afford the tests so your life expectancy is jeopardized.

The American Society of Transplant Surgeons, the International Society for Heart and Lung Transplantation and the American Society of Transplantation have written letters to the contractor explaining the need for the tests. The surgeons’ group notes the change makes no sense when CMS itself has “clearly acknowledged that transplantation is the best, and most cost-effective, treatment option.”

A bipartisan letter from 12 members of Congress, including Rep. Michael Burgess(R., Texas) and Rep. Anna Eshoo (D., Calif.), to CMS administrator Chiquita Brooks-LaSure has asked for coverage to be restored. They note that MolDX’s policy may especially harm poor communities that have “less access to specialized transplant centers, making non-invasive diagnostic tests even more critical for their ongoing post transplant care.”

Remember those famous words of terror: “I’m from the government and I’m here to help!”

Regular readers of this blog know that when I’m not writing about healthcare-related subjects, school choice is my next most favorite topic. The reason is simple – school choice is the key to a good education for children of all socioeconomic levels. And a good education is the key to a productive future for everyone.

Former Secretary of State Condoleeza Rice has called school choice “the civil rights issue of our times.” Low-income families of all races have discovered that school choice allows their children to escape poverty and achieve the American dream. That issue alone is convincing more and more Democrats into voting Republican.

The biggest obstacle for advocates of school choice is the teachers unions. The teachers unions realize school choice is an existential threat to their livelihoods. So it’s no surprise they fight back against school choice with every fiber of their being. What is a surprise, however, is when they send their own children to private schools.

Chicago Teachers Union President Stacy Davis Gates has been at the forefront of the battle against school choice. The Wall Street Journal editorial board says she has called school choice racist and made it her mission to kill an Illinois scholarship program for low-income children.

WSJ says, “So how did Ms. Gates try to explain herself this week after press reports that she has enrolled her son in a private Catholic high school? “Dear Union Sibling,” began her email to fellow teachers. She said that black students have “limited” options on the city’s south and west sides: “It forced us to send our son, after years of attending a public school, to a private high school so he could live out his dream of being a soccer player while also having a curriculum that can meet his social and emotional needs.”

In other words, “Public school for thee, but not for me!” Oh, the hypocrisy! It’s no surprise that she would desire to do what’s best for her child – that’s what every parent should want! But how can she justify doing this for her child but opposing measures like school choice that make it possible for everyone’s child?

The school where her son is enrolled reportedly costs her $16,000 a year. What about those who can’t afford such a school? Illinois’ Invest in Kids program funds about 9,000 scholarships, and last year it had 31,000 applications. But the program is scheduled to sunset, and that’s exactly what the teachers unions have demanded.

She seems to understand the problem. Her own email says, “Here is the truth: If you are a Black family living in a Black community, high-quality neighborhood schools have been the dream, not the reality.” Yet she won’t be a part of the solution – advocating school choice – because her union job demands she oppose school choice. For some schools on the south side of Chicago, the percentage of students who can read or do math at grade level is in the single digits. But then Gates insists, as the teachers unions always do, that the answer is spending yet more money to “undo the decades of systemic underinvestment.”

WSJ tells us the operating budget for the Chicago public schools has grown to $8.5 billion in 2024, from $6.3 billion in 2020, according to the Illinois Policy Institute. Yet enrollment is down 80,000 students from a decade ago, and many schools are underutilized.  Clearly, throwing more money at a failed system is no solution.

The problem is failing public schools and teachers unions are a big part of that problem. The solution is school choice, and most states are realizing this and making it more available. Florida recently passed legislation that permits every Florida student, regardless of their economic status, to have school vouchers worth $8,000 to use to pay for private or parochial schools.

Ms. Gates understands the problem, but her job makes her blind to the solution. Maybe it’s time she looked a little closer in the mirror.

It’s that time of year again when booster shots are soon to be available. We’ve been conditioned for years to get the latest flu vaccine booster to ward off influenza infection. Last year we added a Covid booster shot to the annual routine. Is it time to do that again?

Maybe. Maybe not. It’s really too soon to know for sure. But here is what we do know.

In a new article published in The Wall Street Journal, Dr. Marty Makary of Johns Hopkins University says President Biden declared last week that a new Covid booster shot “works” and is “necessary.” At least that’s what someone told him to say. He said he would ask Congress to fund it and “it will likely be recommended that everybody get it no matter whether they’ve gotten it before.”

Dr. Makary asks, “Is this our new approval process? There are no human-outcomes data on this new shot, which the Food and Drug Administration is expected to approve in the next two weeks.”

Undermining the normal scientific and regulatory process erodes public trust. Last fall the administration approved and recommended a novel Covid bivalent booster with no human data. Only 20.5% of American adults took it, and some were compelled to do so by employers or schools. The recommendation was based on mouse data and failed to recognize the 100,000-fold risk difference between a healthy young person and a comorbid elderly adult. The government paid $4.9 billion for 171 million doses, the vast majority of which went to waste.

Will this new booster mitigate against the severity of Covid infection?

Maybe. Maybe not. Dr. Makary says it’s possible a new booster will mitigate against the severity of Covid infection, but the variants it targets are fleeting. Press releases from Pfizer, Moderna, and Novavax state that their new boosters work on the two dominant variants in circulation today, known as EG.5 and FL.1.51. But we don’t know which variant will be dominant later this winter when it matters. A newer variant, for which the novel booster vaccine has unknown efficacy, has already been identified in Michigan and outside the U.S.

If flu shots get approved without a randomized trial, why not Covid boosters?

Advocates of the new Covid boosters point out that the annual flu shot gets approved without a randomized trial. But flu shots use a traditional vaccine platform that has withstood the test of time, and Covid vaccines have higher complication rates. The latter have a rate of serious adverse events as high as 1 in 556 doses, according to a study published last year in the journal Vaccine. They have also been found to cause myocarditis in young people at a rate six to 28 times the incidence after infection, according to a 2022 JAMA Cardiology study.

Dr. Makary says, “The novel Covid booster shot may be warranted for some high-risk patients. But pushing it hard for young and old alike without human-outcomes data makes a mockery of the scientific method and our regulatory process.”

I am generally a strong advocate of taking vaccines and I’ve taken the primary series of Covid shots plus one booster shot last year. But the track record for these shots has been less than great with many people still getting Covid infections (like my wife) despite taking the vaccines. It is likely these vaccines have reduced the severity of the illness and for that we should be grateful. But Dr. Makary makes some good points for consideration when it comes to the newest vaccines.

My advice is to wait and see before being the first to stand in line for the latest boosters unless you are in a high-risk category and your doctor strongly recommends you get the shot. Chances are we will learn more in the next few weeks to months that may influence our decision regarding the newest Covid boosters.

(Author’s Note: If you would like more information about each of the latest Covid vaccine boosters, click on the following link to Yale Medicine.)