Kidney transplant controversies on World Kidney Day

 Yesterday, March 10 was World Kidney Day, whose theme was "Kidney health for all."

I couldn't help noticing that reports in honor of WKD reflect some of the considerable controversy that exists about kidney transplants.

Here are two with opposite points of view on increasing access to kidney transplants, with special attention to kidney exchange.

First, from Abu Dhabi:

World Kidney Day: SEHA Kidney Care leads the way in ensuring kidney health for all

"A key area that SKC is spearheading is investing in opportunities to increase transplant activities, for patients locally and further afield.  SEHA’s recent collaborations with international organizations and the Department of Health – Abu Dhabi have ensured that it is prepared for an influx in transplant volumes, with an increased deceased donor activity from 3 donors in 2017 to 39 donors in 2021, and more opportunities for live donation with the start of a paired kidney exchange program in partnership with Alliance for Paired Kidney Donation. Through these partnerships, kidney transplants, often resulting in enhanced quality of life, are now a viable option for many patients here in the UAE. SEHA’s Transplant Program has performed more than 52 pediatric kidney transplants and almost 393 transplants in total since its inception.

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And here, from the Pakistani newspaper Dawn, is an editorial that bemoans the prevalence of black market kidney transplants in Pakistan, and worries that increasing access to  kidney exchange will only increase the black market (as opposed to giving patients a safe and legal alternative to the black market). This is an opinion that seems to underlie the policies of a number of international transplant organizations.

Swap Transplants

"IRONICALLY, the Punjab government’s recent step in the effort to stop organ trafficking may well end up providing a shot in the arm to the illegal transplant racket. At a meeting chaired by the Punjab health minister, the provincial government has given its approval to a swap transplant plan which expands the living donor pool beyond immediate family members.

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"Organ swap transplants, or paired exchanges, work by matching a recipient-donor pair that is medically incompatible, with another pair in a similar predicament. An organ ‘swap’ can then take place between the two pairs. However, these are only the bare bones of the procedure. It must be carried out according to strict ethical and clinical guidelines if it is not to open the floodgates for illegal transplants. Among these is the requirement that each recipient-donor pair must meet the eligibility criteria laid out in the law.

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"Thus, while paired exchanges are an accepted method of addressing donor-recipient incompatibility, the level of oversight mechanisms needed to prevent abuse are daunting — even more so in an unequal society riddled with corruption. The first paired kidney exchange in Pakistan was performed in 2015 at the Sindh Institute of Urology and Transplantation in Karachi; only seven more have taken place since then — all at SIUT — partly because of the extreme diligence that the process calls for. The troubling fact is that most illegal transplants take place in Punjab; some were found to have been carried out surreptitiously in KP and Azad Kashmir by doctors from Punjab. The situation in recent years had improved considerably after several organ trafficking gangs were busted, again mostly in Punjab. Does the province have a system in place to ensure that unethical individuals do not use the organ swap programme as a cover for illegal transplants?"

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And here's a recent BBC video, "Kidneys for Sale?" on the controversy about compensation for donors. I just saw it yesterday (HT David Klinowski) but was produced earlier this year. A number of people are interviewed, and Sally Satel makes the point that increasing access to legal, safe kidney transplants is a way of competing with and reducing the prevalence of black markets.