Friday, January 29, 2010

Moving towards kidney exchange on a national scale in the U.S.

There are lots of good reasons to move towards kidney exchange on a national scale (the main ones being the benefits of a thick market). One approach is to try to organize kidney exchange nationally, and I continue to have some hope for that, although organizing a national program involves the difficulty of creating a top-down logistical structure, as well as a Byzantine political struggle.

Another approach is to have the existing regional exchanges merge and grow until they have national reach. This approach presents logistical problems of its own. The two big regional exchanges with which I've been most intimately involved, the New England Program for Kidney Exchange (NEPKE) and the Alliance for Paired Donation haven't yet managed to work well together, although each has expanded its reach and worked well with hospitals outside of their original regions.


One vision of how things might develop in the intermediate term can be gleaned from the Paired Exchange Program at the University of Minnesota Medical Center, led by the eminent Dr. Arthur Matas. A recent post on their blog discusses the three exchange networks in which they take part:


"At the University of Minnesota Transplant Center we are participating in three exchange lists:
North Central Donor Exchange Cooperative which is based in the upper midwest. There are 9 transplant centers in this consortium. The website is http://www.ncdec.org/.
Alliance for Paired Donation (APD) is based at University of Toledo, Ohio. It started in 2007. Currently there are 69 transplant centers from across the country that are registering pairs for matching in this database. This exchange has been using non-directed donors to optimize the number of transplant possibilities. A non-directed donor is someone who wants to donate a kidney to anyone who needs it. A non-directed donor's involvement can allow a long chain of transplants to occur, spread out over a period of months. For example, a non-directed donor gives a kidney to a recipient in the database. That recipient's "mismatched" donor then agrees to give a kidney to someone else, as soon as a match becomes available. In this way, several donations can take place in a chain over time. There has been a successful chain of as many as 10 transplants. You can learn more about paired exchange at http://www.paireddonation.org/.
National Kidney Registry is based in New York. There are 30 transplant centers from across the U.S that are registered with this network. They have done 61 transplants to date. Their website is http://www.kidneyregistry.org/. "


Of course, one of the logistical problems that participation in multiple networks poses is that, unless the timing of their operations is coordinated, networks may essentially compete for particular patient-donor pairs, with more than one network planning surgeries involving a particular pair.

2 comments:

Anonymous said...

Some of this information is outdated. The National Kidney Registry is a national program and the most productive exchange in the world. NKR has facilitated 91 transplants to date with 62 completed in 2009. We are working with 48 transplant centers including 75% of the top living donor centers (6 of the top 8). www.kidneyregistry.org

Dave said...

The generosity of live organ donors is wonderful. It's a shame we need so many live organ donors. Americans bury or cremate 20,000 transplantable organs every year.

There is another good way to put a big dent in the organ shortage -- if you don't agree to donate your organs when you die, then you go to the back of the waiting list if you ever need an organ to live.

Giving organs first to organ donors will convince more people to register as organ donors. It will also make the organ allocation system fairer. About 50% of the organs transplanted in the United States go to people who haven't agreed to donate their own organs when they die.

Anyone who wants to donate their organs to others who have agreed to donate theirs can join LifeSharers. LifeSharers is a non-profit network of organ donors who agree to offer their organs first to other organ donors when they die. Membership is free at www.lifesharers.org or by calling 1-888-ORGAN88. There is no age limit, parents can enroll their minor children, and no one is excluded due to any pre-existing medical condition. LifeSharers has over 13,500 members.