The Pittsburgh Tribune-Review reviewed records from the U.S. Renal Data System and found that some patients spend five years receiving debilitating dialysis treatments before they're put on the nation's kidney transplant list, while others who could benefit from transplants never make the list.

The newspaper found that kidney transplants add an average of 10 years to a patient's life and that a transplanted kidney costs Medicare about $50,000 less than treating a patient using dialysis. Still, the newspaper found the biggest dialysis providers need large numbers of patients covered by insurance to offset lower payments the providers get for dialysis from Medicare.

"In the ideal world, were money not an issue and if everyone was honest, everyone would be referred to a transplant right away," Dr. Bruce Kaplan told the newspaper. Kaplan is chief of nephrology and medical director of the Abdominal Transplant Program at the University of Arizona Medical Center.

The newspaper found that 32,000 of nearly 106,000 people who started treatment for kidney failure in 2006 weren't told about the option of a transplant, according to the latest information from the Centers for Medicare and Medicaid Services. And only 16 percent of dialysis patients were listed for kidney transplants in 2006, even though the federal government's goal is 30 percent by next year.

"Transplantation ought to be mandated because the outcomes are better, the quality of life is better and it's less expensive," said Dr. Tom Parker III, a Dallas nephrologist who co-chaired a summit on dialysis failures at Harvard Medical School in the spring.

The newspaper found that the $65 billion-a-year dialysis industry needs insured patients to offset losses from treating Medicare patients and to make profits, according to corporate filings by dialysis providers.

But some doctors say there aren't enough organs available for all kidney patients. Nearly 56,000 people are waiting for kidney transplants in the United States, but only 16,000 get them each year, said the United Network for Organ Sharing, a national nonprofit that tracks transplants.

And some dialysis companies reject the idea that patients aren't told about all treatment options, including transplants.

"The idea that people would not be informed so we could make money, I completely reject that," said Dr. Allen Nissenson, chief medical officer of DaVita, which has about 1,500 dialysis clinics.

DaVita's patients are given lists of transplant surgeons and centers within 90 days of starting the treatments, Nissenson said.

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