Over at his Market Design blog, Al Roth has posted about our new article, forthcoming in the American Journal of Transplantation. From his post:
Kidney Exchange to Overcome Financial Barriers to Kidney Transplantation
by
Michael A. Rees, Ty B. Dunn, Christian S. Kuhr, Christopher L. Marsh, Jeffrey Rogers, Susan E. Rees, Alejandra Cicero, Laurie J. Reece, Alvin E. Roth, Obi Ekwenna, David E. Fumo, Kimberly D. Krawiec, Jonathan E. Kopke, Samay Jain, Miguel Tan, Siegfredo R. Paloyo
Accepted manuscript online: 7 November 2016
"This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/ajt.14106"
Abstract:
Organ shortage is the major limitation to kidney transplantation in the developed world. Conversely, millions of end-stage renal disease patients in the developing world die because they cannot afford renal replacement therapy—even when willing living kidney donors exist. This juxtaposition between countries with funds but no available kidneys and those with available kidneys but no funds, prompts us to propose an exchange program utilizing each nation's unique assets. Our proposal leverages the cost savings achieved through earlier transplantation over dialysis to fund the cost of kidney exchange between developed-world patient/donor pairs with immunological barriers and developing-world patient/donor pairs with financial barriers. By making developed-world healthcare available to impoverished patients in the developing world, we replace unethical transplant tourism with global kidney exchange—a modality equally benefitting rich and poor. We report the one-year experience of an initial Filipino pair, whose recipient was transplanted in the US with an American donor's kidney at no cost to him. The Filipino donor donated to an American in the US through a kidney exchange chain. Follow-up care and medications in the Philippines were supported by funds from the US. We show that the logistical obstacles in this approach, although considerable, are surmountable.
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And here's that first GKE chain to date: it started with an American non-directed donor (blood type A) donating to the Filipino patient, and this chart shows the first 11 transplants that resulted.
I blogged about GKE before (back when we were calling it Reverse Transplant Tourism – admittedly a less palatable name than Global Kidney Exchange). Mike Rees and I floated the idea as a hypothetical in Reverse Transplant Tourism, part of the Law & Contemporary Problems volume, Organs & Inducements. Back then, we proposed that a simple 2-way swap could help US incompatible pairs and developing world pairs (whether biologically incompatible or not), while also saving money, by leveraging the cost savings of transplantation over dialysis. In practice, though, and as shown by the figure posted by Al, the first GKE helped a Filipino patient unable to afford transplantation on his own, while also facilitating a chain that has transplanted 11 US patients so far.
This video of the first GKE transplant is both informative and uplifting.
Related posts:
Reverse Transplant Tourism (cont.)
We live in an a Reaganesque hyper free market era, now affirmed once again by Trumpism. Why not an Ebay style auction for the kidneys of unemployed coal miners?
Posted by: Captain Hruska Carswell, Continuance King | November 22, 2016 at 02:11 PM
It is good to exploit the organs of humans in poor countries, while offering "first world" health care to a limited number of them. SOrt of like capitalism in China.
Question: Why did Kristine agree to donate her kidney?
Posted by: anon | November 22, 2016 at 09:24 PM
Presumably, anon, for the same reason anyone donates as part of a kidney swap - she didn't want her husband to die
Posted by: Kim Krawiec | November 23, 2016 at 08:31 AM
We act so high handed and officious when it comes to selling human organs on the open market to the highest bidder. "Oh NO!! It's exploitation." That's hogwash. We allow impoverished human beings in Mexico and China to break down our "recycled" heavy meatal contaminated electronics. We allows folks in Bangledash or Vietnam to produce our clothing in seat shops. We allow folks to mine dangerous minerals for consumer goods.... I can go on and on.
Posted by: Captain Hruska Carswell, Continuance King | November 28, 2016 at 11:09 AM