title: Kidney Exchange to Overcome Financial Barriers to Kidney Transplantation.
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.
authors.affiliation: University of Toledo Medical Center, Toledo, OH.|Alliance for Paired Donation, Perrysburg, OH.
authors.forename: M A
authors.initials: MA
authors.lastname: Rees
authors.affiliation: University of Minnesota, Minneapolis, MN.
authors.forename: T B
authors.identifier: 0000-0002-5941-0659
authors.initials: TB
authors.lastname: Dunn
authors.affiliation: Virginia Mason Medical Center, Seattle, WA.
authors.forename: C S
authors.initials: CS
authors.lastname: Kuhr
authors.affiliation: Scripps Green Hospital, La Jolla, CA.
authors.forename: C L
authors.initials: CL
authors.lastname: Marsh
authors.affiliation: Wake Forest Baptist Medical Center, Winston-Salem, NC.
authors.forename: J
authors.initials: J
authors.lastname: Rogers
authors.affiliation: University of Toledo Medical Center, Toledo, OH.|Alliance for Paired Donation, Perrysburg, OH.
authors.forename: S E
authors.initials: SE
authors.lastname: Rees
authors.affiliation: ABC Medical Center, Mexico City, Mexico.
authors.forename: A
authors.initials: A
authors.lastname: Cicero
authors.affiliation: Alliance for Paired Donation, Perrysburg, OH.
authors.forename: L J
authors.initials: LJ
authors.lastname: Reece
authors.affiliation: Stanford University, Stanford, CA.
authors.forename: A E
authors.initials: AE
authors.lastname: Roth
authors.affiliation: University of Toledo Medical Center, Toledo, OH.|Alliance for Paired Donation, Perrysburg, OH.
authors.forename: O
authors.initials: O
authors.lastname: Ekwenna
authors.affiliation: University of Toledo Medical Center, Toledo, OH.|Alliance for Paired Donation, Perrysburg, OH.
authors.forename: D E
authors.initials: DE
authors.lastname: Fumo
authors.affiliation: Duke University, Durham, NC.
authors.forename: K D
authors.initials: KD
authors.lastname: Krawiec
authors.affiliation: Alliance for Paired Donation, Perrysburg, OH.
authors.forename: J E
authors.initials: JE
authors.lastname: Kopke
authors.affiliation: University of Toledo Medical Center, Toledo, OH.
authors.forename: S
authors.initials: S
authors.lastname: Jain
authors.affiliation: Piedmont Hospital, Atlanta, GA.
authors.forename: M
authors.initials: M
authors.lastname: Tan
authors.affiliation: University of the Philippines-Philippine General Hospital, Manila, Philippines.|St. Luke's Medical Center-Global City, Manila, Philippines.
authors.forename: S R
authors.initials: SR
authors.lastname: Paloyo
mesh_terms: D003362:Cost-Benefit Analysis; D003906:Developing Countries; D033001:Directed Tissue Donation; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D017048:Health Care Costs / Q000331:legislation & jurisprudence*; D006295:Health Resources; D006297:Health Services Accessibility; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics* / Q000601:surgery; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000191:economics* / Q000331:legislation & jurisprudence / Q000379:methods; D019520:Living Donors / Q000600:supply & distribution*; D010679:Philippines; D011050:Policy Making; D011379:Prognosis; D012307:Risk Factors; D009927:Tissue and Organ Procurement / Q000191:economics* / Q000379:methods; D014481:United States
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