Global kidney exchange celebrated together with the Declaration of Istanbul, in the AJT

Here's the recent AJT Report from the American Journal of Transplantation,

which touches on various aspects of kidney politics, including global kidney exchange:

Ten‐Year Celebration ofthe Declaration of Istanbul

Lara C. Pullen

First published: 29 October 2018

https://doi.org/10.1111/ajt.15138

Abstract  "This month's installment of “The AJT Report” discusses updates to the Declaration of Istanbul on this key achievement's 10th anniversary. We also report on Italy's recommendation earlier this year regarding the Global Kidney Exchange, and join the transplantation community in bidding farewell to writer and “The AJT Report” originator, Susan Pondrom."

Here's the part about Global Kidney Exchange :

"

Italy Recommends Global Kidney Exchange to the World Health Organization

"In January 2018, Italy recommended a proposal for a global kidney exchange (GKE) to the World Health Organization (WHO).1 The recommendation was part of a collection of statements submitted by Member States and other participants of the 142nd session of the WHO Executive Board.

"Michael Rees, MD, PhD, a kidney transplant surgeon at the University of Toledo Medical Center in Ohio, and Alvin Roth, PhD, a Nobel Prize–winning economist at Stanford University in Palo Alto, California, launched GKE to address the reality that poverty is the biggest global barrier to transplantation and to develop a means for poor people from developing countries to donate and receive organs.2 At its core, GKE is a system to support transplant surgeons in their efforts to help people who are not only very sick and dying, but also too poor to afford dialysis. The system is also controversial in the transplantation community and has been associated with logistical barriers. Even so, Dr. Rees and Dr. Roth remain dedicated to seeing the system developed and implemented around the world.

"The statement from Italy represents a significant endorsement of GKE. It notes that internationally, 2 million to 7 million people die annually from kidney failure, and that kidney disease and other noncommunicable diseases have replaced communicable diseases as the most common causes of premature death worldwide. However, as billions of dollars are spent in low/middle‐income countries (LMICs) to reduce the burden of communicable diseases, significantly less is spent on noncommunicable diseases such as kidney failure. The statement asserts that not only is transplantation the preferred treatment for kidney failure, but that kidney exchange makes it possible to extend the reach of living donation, and for healthy living donors whose kidneys are incompatible with loved ones to exchange their kidneys for those that are compatible with the people they love.

"The first of Italy's action items stated, “We encourage WHO to include organs and in particular kidney transplantation in its program as we believe that oversight, cooperation and assistance of the WHO to carry out a pilot program with strong international governance that is consistent with the highest ethical and legal standard, and that carefully approves participating countries, facilities, healthcare providers and patient–donor pairs should be conceived and implemented.” Italy's statement referred to GKE, noting that such a program allows patients to receive a compatible kidney from another patient's donor. The statement also noted that the savings attained in high‐income countries could support long‐term care of the LMIC donor and recipient in their home country.

"This request sits in conflict with the 2017 Statement of the Declaration of Istanbul Custodian Group concerning ethical objections to the proposed GKE Program.3"

• 1Italian Government. Statement from Italy. WHO, Geneva, Switzerland, 2018. Retrieved from http://apps.who.int/gb/statements/eb142/PDF/22/Italy-3.1.pdf.
• 2Pullen LC. Global kidney exchange: Overcoming the barrier of poverty. Am J Transplant. 2017;17:2499‐2500.
  Wiley Online LibraryPubMedWeb of Science®Google ScholarFind it @ Stanford
• 3Declaration of Istanbul Custodian Group. Statement of the Declaration of Istanbul Custodian Group Concerning Ethical Objections to the Proposed Global Kidney Exchange Program. 2017. Retrieved from https://www.declarationofistanbul.org/resources/policy-documents/795-statement-of-the-declaration-of-istan-bul-custodian-group-concerning-ethical-objections-to-the-proposed-global-kidney-exchange-program
• ***********
• The statement by the group that calls itself the 'Declaration of Istanbul Custodian Group,' is a very strange document: it opposes GKE, on the basis of a series of misleading, confused and sometimes outright false statements about it, and recommends that patients in poor countries who presently cannot afford transplantation should wait until their countries become wealthy enough to provide transplantation to all their citizens domestically, for fear that they would be exploited by being allowed to participate in what for them would be life-saving kidney exchange in countries that have it.
• Of course, the goal of having all nations able to adequately take care of their citizens who need transplants is worth working towards. No nation can yet claim to have reached that point, and international cooperation is a step in that direction.

See all my posts on Global Kidney Exchange here.