NKR in the NYT

 Today's NYT has a story on the country's largest kidney exchange network, a private company with opaque finances called National Kidney Registry (NKR). The story also raises questions about some of the promises NKR makes through a voucher program.

 How One Father Created an Organ Empire.  The National Kidney Registry has matched thousands of kidney donors with recipients. It has also paid millions of dollars to a company owned by its founder.    By  Danielle Ivory, Grace Ashford and Robert Gebeloff 

 "Since its founding, N.K.R. has enabled nearly 12,000 such swaps, called paired donations, far more than any other public or private program. The organization’s focus on technology and efficiency has jolted a sluggish system, many health experts said.

But at the same time, N.K.R. has created a multimillion-dollar business with considerable power over the flow of thousands of organs, according to interviews with more than 100 people in transplant medicine and a review of business records. Many doctors told The Times the stakes of these lifesaving exchanges were too high to be managed by a private company with little government oversight.

...

"The organization was a nonprofit for more than a decade, but during that period paid at least $39 million for technology and other services to a company owned by Mr. Hil, charity filings show. In 2023, N.K.R.’s commercial operations were sold to a new for-profit company owned by Mr. Hil, making its finances much more opaque. 

...

“It’s basically a money transfer,” said Dr. Lloyd Ratner, a surgeon at Columbia University who performed the second-ever paired transplant in the country. He said the hospital had parted ways with N.K.R.

...

"One of N.K.R.’s most innovative policies, many doctors said, is known as voucher donation: Donors can choose to give their kidneys immediately, in exchange for organ vouchers their loved ones redeem later.

"This arrangement has helped N.K.R. expand its pool. But vouchers add risk for donors giving on behalf of hard-to-match patients. They might go through surgery months or even years before their loved ones get a match. Matches are especially unlikely, doctors said, for “very highly sensitized” patients who carry antibodies likely to reject a transplant.

...

" Doctors told The Times that they knew of some patients who became too sick or died before they redeemed their vouchers."

####### 

 

Not mentioned in the article is the Alliance for Paired Kidney Donation (APKD) a smaller, older, highly ethical non-profit kidney exchange network founded by the transplant surgeon Mike Rees (with whom I often work).