Friday, June 18, 2010

Misc. kidney exchange news

A May 17, 2010 story: Innovative Transplant Procedure at Emory Opens Door to More Patients in Need

"The Emory Transplant Center at Emory University Hospital in Atlanta has recently opened its innovative Paired Donor Kidney Exchange Program, providing greater hope for patients in need of kidney transplants."
"Dr. Newell and his team this past month completed the third paired donor exchange surgeries involving a total of six patients - three donors and three recipients - from Texas, Colorado and Georgia. As part of this, as well as one of the two previous exchanges, Emory partnered with the Texas Transplant Institute in San Antonio, the largest independent paired donor program in the country. The program is led by Adam Bingaman, MD, a former Emory trainee who completed both his residency in general surgery and his PhD work at Emory School of Medicine. "To get the ball rolling initially on our program here at Emory, one of the first things we did was partner with the Alliance for Paired Donation," says Dr. Newell. "APD maintains a database of patients who have incompatible donors from over 50 other transplant centers, and the Alliance runs a computer program once a month to find matches between them.
"After about a year, we decided to focus on developing our own database rather than depending on APD's, and we naturally approached Dr. Bingaman about collaborating," says Newell. "Now, building our own listing of donor-recipient pairs remains paramount, an effort expedited by weekly meetings and consultations. Whenever new candidates are added, the data is shared with Dr. Bingaman's program, further increasing each patient's chance of receiving a compatible kidney from a living donor.""

Here's a paper in the June 2010 American Journal of Transplantation:
Ethical Considerations for Participation of Nondirected Living Donors in Kidney Exchange Programs
E.S. Woodle, J. A. Daller, M. Aeder, R. Shapiro, T. Sandholm, V. Casingal, D. Goldfarb, R. M. Lewis, J. Goebel and M. Siegler ; for the Paired Donation Network

ABSTRACT Kidneys from nondirected donors (NDDs) have historically been allocated directly to the deceased donor wait list (DDWL). Recently, however, NDDs have participated in kidney exchange (KE) procedures, including KE 'chains', which have received considerable media attention. This increasing application of KE chains with NDD participation has occurred with limited ethical analysis and without ethical guidelines. This article aims to provide a rigorous ethical evaluation of NDDs and chain KEs. NDDs and bridge donors (BDs) (i.e. living donors who link KE procedures within KE chains) raise several ethical concerns including coercion, privacy, confidentiality, exploitation and commercialization. In addition, although NDD participation in KE procedures may increase transplant numbers, it may also reduce NDD kidney allocation to the DDWL, and disadvantage vulnerable populations, particularly O blood group candidates. Open KE chains (also termed 'never-ending' chains) result in a permanent diversion of NDD kidneys from the DDWL. The concept of limited KE chains is discussed as an ethically preferable means for protecting NDDs and BDs from coercion and minimizing 'backing out', whereas 'honor systems' are rejected because they are coercive and override autonomy. Recent occurrences of BDs backing out argue for adoption of ethically based protective measures for NDD participation in KE.

Paying It Forward
Tulane surgeons performed what is believed to be the first “domino” paired-donor kidney exchange in Louisiana at Tulane Medical Center. Three patients in dire need of a kidney transplant received new organs from people they had never met.

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