Indian Society of Organ Transplantation 2021 Annual Meeting, Oct 7-10

 31st Annual Conference of The Indian Society of Organ Transplantation 7th to 10th October 2021 GRAND HYATT LULU BOLGATTY CONVENTION CENTER in Kochi (Cochin)

My talk (via Zoom) tomorrow morning in CA/evening in India will be on 

"Kidney exchange, around the world and in India"

http://www.isot2021.com/images/pop1.jpeg?refresh=210923023039

ABOUT ISOT 2021 KOCHI  Virtual Conference

"It is our pleasure to invite you to the 31st Annual Conference of the Indian Society of Organ Transplantation, ISOT 2020 Kochi a programme organized by team of Transplant Professionals of Kochi to be held at hotel Grand Hyatt, Lulu Bolgatty Convention Centre from 07th to 10th of October 2021. We are fortunate to have renowned experts across the globe as speakers. This conference will also give you an opportunity to interact with the experts in the field. Wide range of topics, venue of International standard, best hospitality in the Gods own country of Keralam will be the highlights.

"Grand Hyatt Kochi is a Luxury 5 star deluxe waterfront hotel overlooking the serene waters of Vembanad lake with a range of dining, wellness and enriching experiences.

"With a large number of advanced tertiary/quaternary care facilities, Kochi has one of the best healthcare facilities in India. It is the prime destination for people seeking advanced healthcare facilities across Kerala. In recent times, it has attracted a large number of patients from all over India, Middle East, African nations as well as from Europe and United States looking for relatively inexpensive but advanced medical care. Kochi is the only city in Kerala that have carried out successful kidney, liver, heart, pancreas and composite tissue transplantation. VPS Lakeshore Hospital, Amrita Institute of Medical Sciences and Research Centre, Medical Trust Hospital, Lisie Hospital, AsterMedicity, Lourde’s Hospital are some of the advanced tertiary/ quaternary healthcare facilities in Kochi.

"Kochi also known as Cochin is the financial and industrial capital and the biggest city of Kerala that offers excellent airline connectivity with direct flights to 22 destinations including all the major cities of the country. It is also known for its salubrious climate particularly during the month of October attracting a large number of tourists from Europe, Americas and rest of Asia as well as domestic tourists. City also flaunts one of the finest natural harbours of the world. Finest beaches, tranquil back waters, luxurious houseboats, multi-cuisine restaurants, and numerous shopping malls are other attractions."

Non-Simultaneous Kidney Exchange Cycles in India: new design, in Transplant International by Kute and Rees et al.

 Perhaps the biggest part of the ongoing design of kidney exchange around the world involves adapting to constantly changing local conditions in patient and donor populations, and the prevailing laws, regulations and medical situation.  In India, where non-directed donation is illegal (except in Kerala), this means that some patients can be transplanted only if long exchange cycles are possible.  In most of the world, the requirement that the surgeries in a cycle be performed simultaneously has prevented this.

The paper below, organized by two of the world's most innovative transplant doctors, Vivek Kute and Mike Rees (first and last authors, in the medical manner), demonstrates a path forward in India. The paper reports 17 very carefully arranged and conducted non-simultaneous (and non-anonymous) kidney exchange cycles, accomplishing 67 transplants. These were performed at the  Trivedi Institute of Transplantation Sciences  (using our software:).

Vivek B. Kute, Himanshu V. Patel, Pranjal R. Modi, Sayyad J. Rizvi, Pankaj R. Shah, Divyesh P Engineer, Subho Banerjee, Hari Shankar Meshram, Bina P. Butala, Manisha P. Modi, Shruti Gandhi, Ansy H. Patel, Vineet V. Mishra, Alvin E. Roth, Jonathan E. Kopke, Michael A. Rees, “Non-simultaneous kidney exchange cycles in resource-restricted countries without non-directed donation,” Transplant International, February 2021.

Abstract: Recent reports suggest that bridge-donor reneging is rare (1.5%) in non-simultaneous kidney exchange chains. However, in developing countries, the non-directed donors who would be needed to initiate chains are unavailable, and furthermore, limited surgical space and resources restrain the feasibility of simultaneous kidney exchange cycles. Therefore, the aim of this study was to evaluate the bridge-donor reneging rate during non-simultaneous kidney exchange cycles (NSKEC) in a prospective single-center cohort study (n=67). We describe the protocol used to prepare co-registered donor-recipient pairs for non-simultaneous surgeries, in an effort to minimize the reneging rate. In addition, in order to protect any recipients who might be left vulnerable by this arrangement, we proposed the use of standard criteria deceased-donor kidneys to rectify the injustice in the event of any bridge-donor reneging.  We report 17 successful NSKEC resulting in 67 living-donor kidney transplants (LDKT) using  23 bridge-donors without donor renege  and  no intervening pairs became unavailable. We propose that NSKEC could increase LDKT, especially for difficult-to-match sensitized pairs (25 of our 67 pairs) in countries with limited transplantation resources. Our study confirms that NSKEC can be safely performed with careful patient-donor selection and non-anonymous kidney exchanges.

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Some previous posts:

Saturday, February 1, 2020

Long kidney exchange in Ahmedabad, India

Wednesday, May 22, 2019

Kidney exchange in India: the legal framework

Tuesday, May 21, 2019

Robot-assisted kidney transplantation in Ahmedabad, India.

Interfaith marriage under attack in India--"love jihad"

 The Washington Post has the story:

It was never easy being an interfaith couple in India. Now some states are making it harder

"Marrying across religious lines has always been a challenge in India, a vast multifaith democracy where the pull of family and tradition remains strong.

"Now politicians in India’s ruling party are contemplating laws to thwart such unions, driven by a conspiracy theory that views them as a tool for conversions.

"At a rally last month, the leader of the country’s largest state warned of the danger of “love jihad,” an inflammatory slur referring to an alleged plot by Muslim men to convert Hindu women through marriage."

Global kidney exchange between Abu Dhabi and Kerala (India)

Here is an article in the newspaper Malayalam Manorama, in Malayalam, the language spoken in Kerala, about a global kidney exchange between hospitals in Abu Dhabi in the United Arab Emirates, and in Kerala in India.

The url hints at the story: the exchange was between a Kerala hospital and a UAE hospital that both used kidney exchange software provided by Mike Rees's organization, the Alliance for Paired Kidney Donation (APKD), to identify the exchange, which was performed in India:

https://www.manoramaonline.com/global-malayali/gulf/2020/08/05/alliance-for-paired-kidney-donation-uae.html

നൽകാൻ ആളുണ്ടായിട്ടും വൃക്ക ലഭിക്കാത്തവർക്ക് ആശ്വാസം

 

The article says SEHA Kidney Care Staff( Anan Purushothaman, Sheenamma Varghese , Siddiq Anwar) with Dr Mike Rees from Alliance For Paired Donation helped find a compatible  kidney donor in India via the “Global Kidney Paired Exchange”. Dr Feroz Aziz then successfully transplanted the two pairs.

Kim Krawiec, through a friend fluent in Malayalam, gives the following summary:

"The article goes on to say that Najla was in want of a kidney donor. Even though she had 3 of her relatives who were ready to donate none of them were compatible. She was asked to get in touch with the organisation called Alliance for Paired Kidney Donation, where they find donors all around the world using the latest technology. With the help of this organisation and the latest technology, not to mention the doctors and nurses she was able to find a compatible donor. At the same time Najma's mother was able to donate her kidney to the Abu Dhabi donor's husband. Now all are well and back to normal life."

Arranged marriage, in India, on television

The Guardian and the Indian Express have the story about a tv show about arranged marriage, a venerable institution that is becoming controversial.

Here's the Guardian:

Indian Matchmaking: Netflix's 'divisive' dating show causes storm
Series following contestants hoping to be chosen for arranged marriage has divided opinion in India
by Hannah Ellis-Petersen

"For some, Indian Matchmaking represents an unacceptable normalising of the regressive standards forced on Indian women to in order to be seen as a “suitable” wife, while pushing the unspoken issue of caste under the carpet.
...
"The eight-part series follows Taparia as she attempts to find appropriate matches for clients both in India and across the world in order to set up arranged marriages, often on behalf of their client’s parents. It is a show set in a world of upper-class affluence, where Indian families can afford to hire Taparia’s expensive services and even fly her across the world to find them, or their children, a suitable match.

"Arranged marriage remains prevalent in India. As Taparia says in the show, arranged marriage is just described as “marriage” while it is “love marriage” that is spoken of as outside the norm. Newspapers are still full of matrimonial adverts where women are reduced to three-line descriptions of their “fair skinned”, “accomplished” or “modern yet traditional” attributes.

"Indian Matchmaking’s uncritical presentation of its clients’ “criteria” – usually fair-skinned women from a “good” family - has come in for particular criticism.

"Critics have said the show perpetuates damaging ideas around colourism and caste – the Hindu system of hierarchy, which rigidly designates someone’s class and social status. Dalits, India’s lowest class, still undergo rampant discrimination and abuse in society while the upper Brahmin caste hold much of the power and influence. Cross-caste marriage in India can get you killed.

“Indian Matchmaking is really a cesspool of casteism, colourism, sexism, classism,” wrote one Twitter user."
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And here's the Indian Express:

Indian Matchmaking: An 8-episode of misguided gender politics, ultimately a betrayal for Indian audiences
By cherry picking its clients and assorting stories it wants to tell, by ticking boxes of caste, religion and class as imperative for an arranged alliance, Indian Matchmaking panders to the West gaze with complying obedience.
by Ishita Sengupta

"Positioned as an outlet to familiarise the world with a practice peculiar to India and Indians; the documentary could have been a first-hand exploration about the evolving origin of a cultural custom and the multifarious ways people go about it. And for millennials back home, it could affirm our rejection of a practice we long recognise as outdated or be a vehicle to convince us of its efficiency in a language we comprehend better than our parents’ monologues. But Indian Matchmaking dilutes an age-old practice by blunting the pointed shards on which it has stood for years. The end result is an eight-episode betrayal for the audience in India and a cut-to-fit documentary about the country and its traditions for the West, confirming every suspicion they nurtured.

"Created by Smriti Mundhra, who previously co-directed A Suitable Girl in 2017, it follows Sima Taparia, one of India’s top matchmakers as she visits her clientele spread across India and abroad. At the very outset, Taparia (“from Mumbai”) insists, “Matches are made in heaven and God has given me the job of making them successful on earth,” thereby placing herself beyond reproach. But in her job of a self-declared messiah (it is never shown how much she earns) intending to bring together people with the supposed divine connection, she falls back on caste, class, complexion, height and sometimes breadth of smiles as plausible criteria for two people to give each other a shot at spending their lives together."
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And Livemint:

Opinion | What economic studies say about our marriage market
 29 Jul 2020,  by Anirudh Tagat
"A matchmaking show on Netflix seems to skim over the market deficiencies that scholars have studied in depth"

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Update:  and this, from the NY Times, Aug 5--

We Need to Talk About ‘Indian Matchmaking’

The Netflix show is controversial. But it tells awkward truths about my community.

By Sanjena Sathian

"It’s easy to applaud stories about rejecting old customs in favor of modern ideals. It’s harder, yet worthwhile, to sit with the subtler tension between tradition and modernity. This is what the great marriage plots have always considered: a mannered society, and how to live within it."

The fall and rise of food supplies in Covid-19 India, by Matt Lowe and Ben Roth

Pandemic lock downs gave food supply a shock in Indian markets, but they have recovered.

COVID Lockdown: How India's Food Supply Chain First Tightened and then Recovered
"Food supply shortages, if any, are driven by state level policy making, rather than consumers’ and suppliers’ fears of contracting COVID-19."
by Matt Lowe and Ben Roth

"In mid-April, the supply of fruits and vegetables at Azadpur, Asia’s largest fruit and vegetable market, had fallen about 50% since the start of India’s nationwide lockdown.

Two months later, updated nationwide data shows that India’s food supply chain appears to have recovered, operating at levels comparable to the same time last year. The story of the recovery is best told with four food facts, the sum of which tell its own tale of governance during the COVID-19 pandemic times.

Food fact 1: Food volumes took a huge hit post-lockdown but have steadily recovered.

...

Food fact 2: Food prices increased post-lockdown but have steadily fallen.

...

Food Fact 3: The early disruption to the food supply chain was highly correlated with the incidence of COVID-19 at the state level, but all states appear to be recovering.

...

Food Fact 4: Within states, there was no relationship between the incidence of COVID-19 and the health of the food supply chain, even in phase 1.

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Earlier post: 

Thursday, April 16, 2020

Corona lockdown, and the food supply chain in India, by Matt Lowe and Ben Roth

Corona lockdown, and the food supply chain in India, by Matt Lowe and Ben Roth

Matt Lowe and Ben Roth look at the effect of India's corona virus lockdown on the food arriving at the big wholesale produce market in Delhi.  They describe breakdowns in the supply chains.

Arrivals Dropped 50% Post Lockdown. When Will Azadpur Mandi’s Supply Return to Normal?
Since the lockdown has been extended till May 3, it has become all the more crucial for the government to intervene and ensure that the broader food supply chain operates smoothly. 

"The disruption can already be seen in Delhi’s (and Asia’s) largest wholesale fruit and vegetable market – the Azadpur mandi – which has seen a precipitous decline in the volume of fruits and vegetables flowing through the market.

"Relative to the three prior years, the volume of produce arriving at Azadpur fell by about half on March 24, and has hovered at around that level since (Figure 1).

Long kidney exchange in Ahmedabad, India

Vivek Kute writes with the news:
IKDRC completes India’s longest cross-transplant chain

"Institute of Kidney Diseases and Research Center, Institute of Transplantation Sciences (IKDRC-ITS) Ahmedabad, India is pleased to share the news of an exciting milestone for the patients with end stage renal disease with incompatible living kidney donors. Our transplant team has completed longest Kidney Exchange transplant chain in India as well as Asia involving 10 donor-recipients pairs over 5 days in January 2020. Two kidney transplant surgeries were performed each on 4, 6 and 7 January, 3 transplants on 8 January and last kidney transplant was completed on 22 January 2020.
...
". The success of this program can be attributed to the selflessness of the more than 500 family members who have stepped forward to be living organ donors. Dr Vivek Kute Professor of Nephrology maintains the single center registry of incompatible pairs. Dr Vivek Kute  and his team is greatful to Prof. Michael Rees and Prof. Alvin Roth for providing the Alliance for Paired Donations software for computer allocation at free of cost. Transplant team members are Dr Vineet Mishra, Dr Pranjal Modi, Dr Himanshu Patel, Dr Jamal Rizvi, Dr Vivek Kute, Dr Bina Butala and others."

Matching in Marathi (the language of Maharashtra)

Ashutosh Thakur points out to me this article in the main Maharashtraian newspaper, ''Loksatta.''

संज्ञा आणि संकल्पना : ..जिथून पडल्या गाठी
अर्थशास्त्रात असलेली, पण आर्थिक व्यवहार नसलेली आपली आजची संकल्पना म्हणजे-मॅचिंग मार्केट्स.

Google translate doesn't make much headway with the top headline, but renders the subheading as
"Matching markets today are our concepts of economics, but not financial transactions."

Inter-caste marriage as a repugnant transaction in India: a hired hitman and a murdered groom

In the U.S. we've had long periods where the future of inter-racial and same-sex marriages were in doubt. In India, inter-caste marriage can still be dangerous.

Here's a story from the Washington Post, about a mixed-caste marriage, a hired hitman, and a murdered groom...

A young Indian couple married for love. Then the bride’s father hired assassins.
By Joanna Slater

"Hundreds of people attended the festivities on Aug. 17, 2018, but Amrutha’s parents were notably absent. Rao, her father, had already begun to plot Pranay’s murder, court documents say. The month before, he agreed to pay $150,000 to have his son-in-law killed, using a local political leader as an intermediary. Rao, 57, passed along a photo of the pair from their reception invitation to make it easier for the killers to identify Pranay, the documents allege."

Indian lower house of Parliament (Lok Sabha) passes bill banning commercial surrogacy

A bill banning commercial surrogacy (and restricting who can take part in altruistic surrogacy) has passed through the Lok Sabha, the lower house of Parliament:

LS Passes The Surrogacy (Regulation) Bill, 2019: Read The Salient Features [Read Bill] BY: AKSHITA SAXENA 6 Aug 2019

 "The Lok Sabha on Monday passed the Surrogacy (Regulation) Bill, 2019, introduced by Union Health Minister Harsh Vardhan. The bill essentially seeks to regulate surrogacy in India while imposing an absolute prohibition on commercial surrogacy."

Under the terms of the proposed law, a surrogate mother would have to be a married close relative of the intended parents, with at least one child of her own.  The intended parents would have to be a childless married couple, Indian citizens married for at least 5 years, with medically certified infertility.

The bill has yet to be passed by the upper house and signed by the president, so at this stage it's not yet the law.
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Here's a news story from the Times of India:
Commercial surrogacy banned in India; government passes tough laws

By - TNN Created: Aug 6, 2019

And from the Hindustan Times, indicating that this bill has some prior history, and so isn't a sure thing to become law:

 Lok Sabha passes bill that bans commercial surrogacy

"The Bill was passed by Lok Sabha in December, 2018 but lapsed as it could not get nod from Parliament.

"Earlier, the Bill was introduced in the Lok Sabha on November 21, 2016 and was then referred to a parliamentary standing committee on January 12, 2017."

Kidney exchange is an intercommunal activity

From the Times of India:
A kidney swap involving Hindu, Muslim families that resurrected faith in humanity 
 

"CHANDIGARH: At a time when communal disharmony has become the norm in many parts of the world, a hospital in Mohali just resurrectected faith in humanity..."

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And from the New Indian Express:

Unique kidney transplant saves Hindu woman from Bihar and Muslim man from Kashmir

The families crossed paths three months after they got themselves registered in a mobile app iKidney, developed by Dr Priyadarshini Ranjan.

      

Kidney exchange in India: the legal framework

Last week in Ahmedabad I had a chance to interact with Dr. Vivek Kute and his colleagues at the Trivedi Institute, to better understand the setting of their innovative kidney exchange program.  The legal framework is of course a big part of that environment.

Here's India's Transplantation of Human Organs and Tissues Act (THOA), 2014 (scroll down for the English language version).

As in other places, much of the law is shaped by  repugnance towards kidney sales. To this end, the law requires that an Authorisation Committee approve donation from someone who is not a "near relative," in the immediate nuclear family.

"Authorisation Committee.
(3) When the proposed donor and the recipient are not near relatives, the Authorisation Committee shall,- 
(i)evaluate that there is no commercial transaction between the recipient and the donor and that no payment has been made to the donor or promised to be made to the donor or any other person; 
(ii)prepare an explanation of the link between them and the circumstances which led to the offer being made;"

In the case of kidney exchange, only a near relative may serve as the intended donor (i.e. no uncles, aunts, cousins, etc.).

"(4)Cases of swap donation referred to under subsection (3A) of section 9 of the Act shall be approved by Authorisation Committee of hospital or district or State in which transplantation is proposed to be done and the donation of organs shall be permissible only from near relatives of the swap recipients."

The present law also does not allow nondirected donors.
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Here are some related earlier posts:

Tuesday, May 21, 2019 Robot-assisted kidney transplantation in Ahmedabad, India.

Monday, July 2, 2018

Kidney exchange in all its aspects: a view from India

Monday, May 14, 2018

Kidney Exchange in India: current conditions and recommendations for the future

Robot-assisted kidney transplantation in Ahmedabad, India.

I just returned from a very interesting visit to Ahmedabad, Gujarat, India, part of which was at the Trivedi Institute of Transplantation Sciences. There I had the privilege of sitting in on a robot-assisted kidney transplant operation conducted by Dr. Pranjal Modi. In the picture below, Dr. Modi is seated at the robot, that he operates with his hands and feet, while I watch on a screen, behind which is the patient (surrounded by doctors maintaining the various instruments inside him, through small incisions).

Dr. Pranjal R. Modi at the robot controls, while I watch him perform a kidney transplant.

Below is the two-dimensional image in which I followed what he was doing (but when he looks through the binoculars of the robot, he sees it in very clear 3 dimensions).

The high magnification is apparently a big aid to fast and precise surgery, which (together with small incisions) is one of the attractions of robotic surgery.

The robot was made by Da Vinci.
I think this is the patient-facing part of the particular robot being used:

Indian Society of Organ Transplantation meeting in Ahmedabad May 11-12

I'll be in Ahmedabad this weekend, starting with a conference of the Indian Society of Transplantation:

http://isot.co.in/file/ISOT_Mid_term_meeting_11-12_May_Ahmedbaabd.pdf

Here's a draft of the program.

My two talks will be on
History and organization of kidney exchange, and
Taboo transactions and frontiers in ethical kidney exchange

Matching civil servants to positions (and career tracks) in India

Stanford's Ashutosh Thakur writes about civil service matching in India:
Rethinking cadre allocation procedures in civil services


 "The allocation procedure of All-India Services’ officers to states is an important aspect of personnel administration in the public sector. This article shows that a change in allocation policy in 2008 resulted in lower quality officers being systematically assigned to disadvantaged states. It examines the causes of these imbalances and impact on State capacity and development outcomes, and explores alternate mechanisms."

Kidney exchange in all its aspects: a view from India

Here's a survey that sees kidney exchange, and all the advances that have been made in how to use it to facilitate more transplants, as a force for making medicine more inclusive around the world.

Kidney exchange transplantation current status, an update and future perspectives
Vivek B Kute, Narayan Prasad, Pankaj R Shah, Pranjal R Modi
World J Transplant. Jun 28, 2018; 8(3): 52-60
Published online Jun 28, 2018. doi: 10.5500/wjt.v8.i3.52

Abstract: "Kidney exchange transplantation is well established modality to increase living donor kidney transplantation. Reasons for joining kidney exchange programs are ABO blood group incompatibility, immunological incompatibility (positive cross match or donor specific antibody), human leukocyte antigen (HLA) incompatibility (poor HLA matching), chronological incompatibility and financial incompatibility. Kidney exchange transplantation has evolved from the traditional simultaneous anonymous 2-way kidney exchange to more complex ways such as 3-way exchange, 4-way exchange, n-way exchange,compatible pair, non-simultaneous kidney exchange,non-simultaneous extended altruistic donor, never ending altruistic donor, kidney exchange combined with desensitization, kidney exchange combined with ABO incompatible kidney transplantation, acceptable mismatch transplant, use of A2 donor to O patients, living donor-deceased donor list exchange, domino chain, non-anonymous kidney exchange, single center, multicenter, regional, National, International and Global kidney exchange. Here we discuss recent advances in kidney exchanges such as International kidney exchange transplantation in a global environment, three categories of advanced donation program, deceased donors as a source of chain initiating kidneys, donor renege myth or reality, pros and cons of anonymity in developed world and (non-) anonymity in developing world, pros and cons of donor travel vs kidney transport, algorithm for management of incompatible donor-recipient pairs and pros and cons of Global kidney exchange. The participating transplant teams and donor-recipient pairs should make the decision by consensus about kidney donor travel vs kidney transport and anonymity vs non-anonymity in allocation as per local resources and logistics. Future of organ transplantation in resource-limited setting will be liver vs kidney exchange, a legitimate hope or utopia?"

An interesting section of the paper discusses different practices regarding anonymity in kidney exchange centers in different countries:

"PROS AND CONS OF ANONYMITY IN DEVELOPED WORLD AND (NON-) ANONYMITY IN DEVELOPING WORLD

There is disparity on standard practice of kidney exchange in developed and developing World in term of (non-) anonymity. There is variable practice on anonymity before and after surgery in different countries.

Conditional approach[38]: When the donor-recipient pairs give consent for meeting after surgery, they are allowed to meet each other after surgery in some countries such as the United States of America[39] and the United Kingdom[40]. In other countries, such as the Netherlands and Sweden[41], anonymity is absolute. Anonymity protects patients, donors and transplant hospital/ administration against the risks of revoking anonymity and prevents further commercialization of organs, and breach of patient donor privacy. An Ethical, Legal and Psychosocial Aspects of Organ Transplantation (ELPAT), a subsection of the European Society for Organ Transplantation reported that a conditional approach to anonymity should be possible after surgery[42]. Pronk et al[38] showed that most donor-recipient pairs who participated in anonymous donation process are in favour of a conditional approach to anonymity. Guidelines on how to revoke anonymity if both parties agree are needed and should include education about pros and cons of (non-) anonymity and a logistical plan on how, when, where, and by whom anonymity should be revoked.

Non-anonymous allocation[11,12]: Donor-recipient pairs are allowed to meet each other before allocation of donor for surgery and even after surgery. They can share medical reports of exchange donors before surgery and kidney transplant and donor surgery outcome after surgery. Donor-recipient pairs do not choose their match but donor-recipient pairs may decline a match or can withdraw from participation in the kidney exchange program at any time, for any reason. Non-anonymous allocation has the potential of commercialization of organs in case of compatible donor-recipient pairs along with breach in privacy of donor-recipient pairs. Kute et al[11,12] reported that donor-recipient pairs are willing for non-anonymous allocation process in single center study of 300 kidney exchange transplants in India. They reported that non-anonymity is more helpful in manual allocation in absence of computer software allocation which also increases trust between patients, donors and transplant hospital/administration and legal team. More long term prospective studies are required to explore the donor and recipient perspective on anonymity in living kidney donation in different socio-economic regions and countries."

Regarding Global Kidney Exchange they conclude:

"Global kidney exchange appears to provide life-saving kidney transplantation to poor donor-recipient pairs from developing countries that otherwise could die due to economic constrain[50-53]."

And here's their conclusion:

CONCLUSION

"Kidney exchange transplantation has increased living donor kidney transplantation for end stage renal disease patients with chronological incompatibility and financial incompatibility. The participating transplant teams and donor-recipient pairs should make the decision by consensus about kidney donor travel vs kidney transport and anonymity vs non-anonymity in allocation as per local resources and logistics. There is need of uniform algorithm for management of incompatible donor-recipient pairs."

Kidney Exchange in India: current conditions and recommendations for the future

The Indian Society of Organ Transplantation has published guidelines for expanding kidney exchange in India:

Kute VB, Agarwal SK, Sahay M, Kumar A, Rathi M, Prasad N, Sharma RK, Gupta KL, Shroff S, Saxena SK, Shah PR, Modi PR, Billa V, Tripathi LK, Raju S, Bhadauria DS, Jeloka TK, Agarwal D, Krishna A, Perumalla R, Jain M, Guleria S, Rees MA. Kidney-paired donation to increase living donor kidney transplantation in India: Guidelines of Indian Society of Organ Transplantation – 2017. Indian J Nephrol 2018;28:1-9

Here's the summary of their recommendations:

"Evidence-based recommendations, suggestions, and expert consensus statements in this document aim to expand KPD and may serve as a model for other developing countries. For these guidelines, all reference articles in the English literature related to KPD transplantation in India from MEDLINE (PubMed from 2000 to 2017) database were included and reviewed.

We recommend that each potential DRP should be educated, encouraged, and counseled about KPD transplant in an easy-to-understand format as early as possible in the process of chronic kidney disease (CKD) care.

We recommend that all the transplant team members including transplant coordinator in addition to other regular training should also be trained for counseling about risk, benefits of KPD, nonexchange options, consent process, financial screening of DRP, data entry-related issues of KPD, and overall support for KPD.

We recommend that a standard written informed consent should be obtained from each DRP. We suggest that DRP should be given information about expected waiting time before transplantation, and every attempt should be made to reduce waiting time, particularly for hard-to-match pairs with the innovative ways in KPD matching.

We suggest that easy-to-match pairs (A donor and B recipient and vice versa) and sensitized pairs should be encouraged for KPD over ABO-incompatible kidney transplantation (ABOiKT) and desensitization protocol.

We recommend that all types of KPD should be practiced only after legal permission as per the existing transplant law.

We suggest that three-way exchange has optimum quality and quantity of matching.

We suggest that potential KPD transplant centers should study the key elements of success of other successful KPD program.

We suggest that computerized algorithms should be encouraged over manual allocation.

We recommend that all patients should be screened for pretransplant immunological risk, occult infections, and other risk factors to prevent and reduce posttransplant unequal outcome due to patient-related factors.

We suggest that the age difference between KPD donors should not be the key issue in allocation and better immunological match may counteract the effect of higher donor–recipient age difference.

We recommend that participating transplant teams should make the decision by consensus about kidney donor travel versus kidney transport as per local resources and logistics, though donor travel rather than kidney transport is likely to be simple.

We suggest that transplant surgery should be performed at the place where patient is evaluated, admitted, and willing to do posttransplant follow-up and simultaneous rather than sequential surgery should be preferred.

We recommend that the formation of KPD registry is one of the principal strategies to improve the quality of matching and number of KPD.

We suggest that DRP needs to be cognizant of transcultural, language, and legal barriers in national program when patients and their donors may belong to different regions or states of India."


And here's the introductory summary of the background in India:

The Indian CKD registry in 2010 reported that at the time of enrolment in registry, 61% of end-stage renal disease (ESRD) patients were not on any form of renal replacement therapy (RRT), while 32% were on hemodialysis, 5% on peritoneal dialysis, and only 2% were being worked up for kidney transplantation.^[1] There is a gross disparity between supply and demand of the transplant organs across the world, including India. All efforts are to be made to increase the supply of quality organs to the waiting transplant recipients. KPD is one such process for increasing supply of organs to patients waiting for transplant. ABO-compatible living donor kidney transplant (LDKT) is the ideal and cost-effective RRT modality for ESRD patients in resource-limited developing country such as India, where morbidity and mortality on long-term dialysis is unacceptably high. Access to RRT is mainly prevented by paucity of facilities and affordability. Up to 80% of kidney donors are living donors, while DDKT programs are still evolving in most parts of India.

KPD transplant enables two incompatible DRP to receive more compatible kidneys. In this, a living kidney donor who is otherwise incompatible with the recipient exchanges kidneys with another DRP. KPD can be performed at any transplant center that is doing kidney transplantation without the need of extra facilities as required for ABOiKT and transplant with desensitization protocol.

Debt traps and money lending

Credit for poor borrowers is a subject of importance in both the developing and developed world. Here's a new paper...

Debt Traps? Market Vendors and Moneylender Debt in India and the Philippines

Dean Karlan, Sendhil Mullainathan, Benjamin N. Roth

NBER Working Paper No. 24272
Issued in February 2018
NBER Program(s):Development Economics, Law and Economics, Productivity, Innovation, and Entrepreneurship 

A debt trap occurs when someone takes on a high-interest rate loan and is barely able to pay back the interest, and thus perpetually finds themselves in debt (often by re-financing). Studying such practices is important for understanding financial decision-making of households in dire circumstances, and also for setting appropriate consumer protection policies. We conduct a simple experiment in three sites in which we paid off high-interest moneylender debt of individuals. Most borrowers returned to debt within six weeks. One to two years after intervention, treatment individuals were borrowing at the same rate as control households.

Kidney exchange in India

Right now, kidney exchange in India is all done in single transplant center programs. Here's an article advocating inter-hospital exchange to increase accesss to transplantation.

Kidney-paired donation to increase living donor kidney transplantation in India: Guidelines of Indian Society of Organ Transplantation – 2017
Kute VB, Agarwal SK, Sahay M, Kumar A, Rathi M, Prasad N, Sharma RK, Gupta KL, Shroff S, Saxena SK, Shah PR, Modi PR, Billa V, Tripathi LK, Raju S, Bhadauria DS, Jeloka TK, Agarwal D, Krishna A, Perumalla R, Jain M, Guleria S, Rees MA
Indian Journal of Nephrology, 2018  |  Volume : 28  |  Issue : 1  |  Page : 1-9

"Conclusion: KPD transplant is legal, cost-effective, rapidly expanding modality with good long-term outcome, and being implemented in several centers in India with the potential to increase LDKT by 25%. KPD transplant should be encouraged over ABOiKT and desensitization protocol. The quality of matching and number of KPD will be superior in national program versus single-center program due to large donor pool. Transplant team members, stakeholder, and policy-makers should work together to expand KPD.

...
These are recommendation on KPD transplantation after the Indian Society of Organ Transplantation (ISOT) midterm meeting organized at Chennai on March 18, 2017, and 1-day Workshop organized at Hotel Pullman, Aerocity, New Delhi, on April 29, 2017, under the Aegis of ISOT and participation of NOTT organization to discuss various issues related to expanding KPD and starting the National KPD program. Transplant surgeons, physicians, and other stakeholders from major centers across the country participated and had a robust discussion on the related issues."