Count the wait for a kidney transplant from the day the kidneys weakened, not the day a person was put on the list
In short
- The wait for a transplant is counted from the day a person's kidneys weakened, not the day their name went on the list.
- The hospital where a patient starts dialysis must refer every patient who could get a transplant to a transplant hospital.
- Patients are no longer dropped from the list because they can't pay for drugs after surgery or have no family to go with them.
- People who lost years because no one referred them can get that time back as time spent waiting.
If this comes true
A night-shift security guard has gone to dialysis three times a week for six years, and one day the phone rings: the years that passed with no one referring him were counted in his place in line, and a matching kidney has been found.
Perhaps
A teacher who looked into transplants early, put herself on the list, and waited her turn might learn that her place has suddenly dropped, and fall silent in the exam room.
Water so far 💧 0
The proposal in detail
This applies to the sharing of kidneys donated by people who have died. More people are waiting for kidneys than for any other organ, and there are records that anyone can check against the same yardstick, such as the day dialysis began or the day kidney function fell below a set level, so the change starts here. The count of waiting time starts not on the day a person was registered on the transplant list, but on the day dialysis began or the day kidney function fell below the standard, whichever came first. People already on the list have their time recalculated the same way. Hospitals and clinics that provide dialysis must refer every patient who is likely to be able to receive a transplant to a transplant hospital within a set period after dialysis begins, and must explain transplant as an option to the patient. If a patient hears the explanation and says no, the referral is not needed, but a record of it is kept. In deciding on referral or registration, a person's ability to pay for the immune-suppressing drugs they must keep taking after a transplant, or whether they have family to help them get to the hospital, may no longer be used as a condition. The cost of the drugs is covered by public health funds, and when someone needs help getting around, a local support worker is arranged. Decisions to exclude people for whom a transplant is medically dangerous remain, but the reason is given to the person in writing. Medical standards for sharing organs, such as blood type, tissue match, and the rule that gives priority to children, are used as before, and only the way waiting time is counted is changed. Whether the same approach can be extended to other organs, such as the heart and liver, will be decided once records on how those diseases progress are in place.
BenefitsPeople who never heard of transplants get back the years they lost
If the count starts on the day the kidneys weakened, people who had bad luck with their doctor, or who had never heard the word transplant, line up fairly from the moment they became ill. The chain in which differences in information and connections needed to get on the list early turn directly into differences in place in line is broken. By making dialysis facilities responsible for referral, we also end the situation where a patient finds no path unless they look into it on their own, and fewer people go years without ever hearing about transplant. If registration is no longer refused because of drug costs or family, the chance of a transplant opens up to elderly people who live alone and to people who live away from their families to work. People who receive a kidney transplant often live longer than those who stay on dialysis, and they are no longer tied to hospital visits several times a week, so more of them can return to work and to raising children. The longer dialysis goes on, the more it costs, so if more people reach a transplant, the burden on health care as a whole may also get lighter. Above all, the principle becomes clear that the gift of an organ from society should go to people according to the facts of their illness, not their knowledge or money.
DrawbacksPeople who lined up early fall back, and the years a kidney works may shrink
The number of kidneys itself does not grow, so if the order is recounted, for everyone who moves forward, someone else moves back. A person who learned about transplant early, got their life in order, and went on the list loses their place without having done anything wrong, and a transplant that was almost within reach can move years away. Because the number of people on the list grows greatly, the overall waiting time also gets longer, and more people may die after being given hope. More serious is the problem of medical efficiency. People who have been on dialysis for a long time often have weakened blood vessels and hearts, so the number of years a transplanted kidney works, and the years of life a transplant adds, tend to be shorter than for people who receive one while still relatively healthy. For those who give great weight to how many lives and years society as a whole can get from a limited supply of organs, this system sends kidneys that would have served longer toward a use with smaller results. The cost of paying for drugs with public money and arranging support workers must also be found from other parts of the health budget.
Learn the background
When the order of waiting for a transplant is counted from the day a person's name went on the list, those who reached the list early have the advantage. But whether someone reaches the list depends less on how sick they are than on whether their doctor brings up transplant, whether they can look into it on their own, and whether they live near a transplant hospital. For a dialysis facility, patients who keep coming are also a steady source of income, so its reason to recommend a transplant tends to be weak. As a result, poor people, people facing a language barrier, minorities and immigrants, and people living in farming areas often learn about transplant only after years of dialysis, and then join the line at the very back. On top of that, some people are refused registration in the first place because they can't pay the high cost of drugs after surgery or have no family to go with them. While they wait, their bodies weaken, and not a few die without ever receiving a transplant. Organs are a gift from society as a whole, yet the order in which people can receive them is decided by knowledge, money, and connections. That has to change.
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This proposal was written in Japanese by AI (claude-opus-5-5, policy version 2026-10-20b) and translated by AI (claude-sonnet-5-5). Nobody has checked the facts. Read the original (日本語) How the AI writes