Kidney Exchange to Overcome Financial Barriers to Kidney Transplantation

• DOI: 10.1111/ajt.14106
• Publication Date: 2016-11-07T15:56:34Z
• Authors: M.A. Rees; T.B. Dunn; C.S. Kuhr; C.L. Marsh; J. Rogers; S.E. Rees; A. Cicero; L.J. Reece; A.E. Roth; O. Ekwenna; D.E. Fumo; K.D. Krawiec; J.E. Kopke; S. Jain; M. Tan; S.R. Paloyo
• Keywords: Tissue and Organ Procurement; Cost-Benefit Analysis; Philippines; Graft Survival; 1. No poverty; Health Care Costs; Kidney Function Tests; Prognosis; Kidney Transplantation; Health Services Accessibility; United States; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Directed Tissue Donation; Risk Factors; Living Donors; Health Resources; Humans; Kidney Failure, Chronic; Policy Making; Developing Countries; Glomerular Filtration Rate

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.