title: Altruistic unbalanced paired kidney exchange at Columbia University/New York-Presbyterian hospital: rationale and practical considerations.
abstract: Paired kidney exchanges are being used with increasing frequency to overcome humoral immunologic incompatibilities between patients in need of renal transplantation and their potential live donors. Altruistic unbalanced exchanges utilize compatible donor/recipient pairs in order to facilitate the transplantation of a patient with an incompatible donor. We have now performed several altruistic unbalanced paired kidney exchanges at our institution. Also, we have surveyed potential donors and recipients regarding their attitudes toward participating in altruistic unbalanced paired kidney exchanges. Patients are most amenable to participation if they perceive a benefit from trading away a compatible donor. Given the number of compatible live donor transplants performed annually, if practiced on a broad scale, altruistic unbalancedpaired kidney exchanges can have a profound impact upon the supply of kidneys for transplantation. These exchanges can be performed at individual centers without the requirement for largesharing pools or complex computer algorithms. However, there are a number of ethical and logistical considerations that must be addressed. Altruistic unbalanced paired kidney exchanges represent a major paradigm shift in renal transplantation, in that a private resource (i.e. the live kidney donor) is converted to a shared or public one.
authors.affiliation: Department of Surgery, Columbia Universityand New York-Presbyterian Hospital, New York, NY, USA.
authors.forename: Lloyd E
authors.initials: LE
authors.lastname: Ratner
authors.forename: Emily R
authors.initials: ER
authors.lastname: Ratner
authors.forename: Joan
authors.initials: J
authors.lastname: Kelly
authors.forename: Maureen
authors.initials: M
authors.lastname: Carrol
authors.forename: Karyn
authors.initials: K
authors.lastname: Cherwinski
authors.forename: Victoria
authors.initials: V
authors.lastname: Ernst
authors.forename: Abbas
authors.initials: A
authors.lastname: Rana
mesh_terms: D000533:Altruism; D001788:Blood Grouping and Crossmatching / Q000941:ethics; D037921:Gift Giving / Q000941:ethics; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016030:Kidney Transplantation / Q000941:ethics; D009519:New York City; D016730:Program Development; D014019:Tissue Donors / Q000941:ethics / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement / Q000941:ethics / Q000458:organization & administration*; D016896:Treatment Outcome