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.