Kidney Exchange to Overcome Financial Barriers to Kidney Transplantation.

Rees MA1,2, Dunn TB3, Kuhr CS4, Marsh CL5, Rogers J6, Rees SE1,2, Cicero A7, Reece LJ2, Roth AE8, Ekwenna O1,2, Fumo DE1,2, Krawiec KD9, Kopke JE2, Jain S1, Tan M10, Paloyo SR11,12.

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Abstract

Organ shortage is the major limitation to kidney transplantation in the developed world. Conversely, millions of patients in the developing world with end-stage renal disease 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 using 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 health care 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 1-year experience of an initial Filipino pair, whose recipient was transplanted in the United states with an American donor's kidney at no cost to him. The Filipino donor donated to an American in the United States through a kidney exchange chain. Follow-up care and medications in the Philippines were supported by funds from the United States. We show that the logistical obstacles in this approach, although considerable, are surmountable.

KEYWORDS:

clinical research/practice; disparities; donors and donation: living; donors and donation: paired exchange; economics; ethics; ethics and public policy; kidney transplantation/nephrology; law/legislation; organ procurement and allocation