In my last blog post, I hinted at a possible conflict of interest between transplant centers and the dialysis industry. That is, transplant centers want to encourage all of their patients with end stage renal disease (ESRD) for whom renal replacement therapy is medically advisable to consider the option. On the other hand, dialysis centers, equipment manufacturers, and pharmaceutical companies believe that they are providing the best treatment option for their patients.

Another Dec 2009 blog post hints at this conflict of interest by noting the low-level of compliance by dialysis treatment centers to the Medicare requirement that they inform patients of the renal replacement therapy option and help patients get on the UNOS waiting list. Dialysis centers want their patients (customers) to be comfortable. It is unlikely the staff wants to make patients anxious by consistently reminding them of the need to find a donor, get a transplant, and get off of dialysis. Further, patients have much more contact with the personnel at the dialysis center, where they go several times a week for several hours per visit, than they do with the physicians at their local hospital (which may not be a transplant center) or with transplant nephrologists or surgeons at a transplant center. Thus, to avoid cognitive dissonance, patients may discount advice they receive from physicians to find a donor since it is an emotionally difficult task and conflicts with the patient’s image of good care they are getting from the dialysis center.

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