Four international kidney exchange programs: 3 achieve substantial success

 Here's a paper reporting on the experience of four cross-border kidney exchange programs, whose experience teaches an important lesson.  In particular (see the figure below), one of  the programs is run by Spain, Italy and Portugal, whose  total population of approximately 118 million people is far larger than the combined population of the other three*, but manages to do less than 5% of the total cross-border exchanges, far fewer than any of the others.  Despite its size, the Spain-Italy-Portugal program only tries to match hard-to-match patient-donor pairs with other hard-to-match pairs, unlike the other three programs.

 International Kidney Paired Donation Programs: Evolution and Practices of 4 Large Collaborations
Klimentova, Xenia PhD1; Domínguez-Gil, Beatriz MD, PhD2; Viana, Ana PhD1,3; Manlove, David PhD4; Andersson, Tommy PhD5; Ashkenazi, Tamar RN, PhD6; Berlakovich, Gabriela MD7; Böhmig, Georg A. MD8; Burton, Jo RN, PGDip9; Coll, Elisabeth MD, PhD2; Dittmer, Ian FRACP9; Fiaschetti, Pamela MD10; Fronek, Jiri MD, PhD11; Hughes, Peter D. MBBS, PhD12,13; Ivo da Silva, Margarida MD14; Mor, Eytan MD15; Viklický, Ondřej MD, PhD16; Weinreich, Ilse Duus BMLS17; Ferrari, Paolo MD, FRACP18,19
Transplantation ():10.1097/TP.0000000000005602, December 24, 2025. | DOI: 10.1097/TP.0000000000005602

"Plain Language Summary: Kidney paired donation (KPD) programs are organized in various countries to facilitate the donation of kidneys from willing but incompatible donors by matching them with pairs in similar situations. These programs often struggle with an accumulation of difficult-to-match recipients and small pools of incompatible pairs. To address this, several international collaborations have emerged to expand the pool sizes and increase the number of transplants by “exchanging” donors’ kidneys across countries. We identified 4 established international KPD programs, each supported by protocols and agreements signed by the participating parties. Each program is presented separately, detailing its historical establishment, operational aspects, and statistics on pool characteristics and performance. Following this, we provide a comparative analysis of key aspects across the 4 programs. Each program has its unique context and specificities. Even though 3 of 4 collaborations started just before the COVID-19 pandemic, they have collectively facilitated >450 transplants. This underscores the importance of further developing these collaborations to share practices and experiences, and to facilitate more transplants, particularly for difficult-to-match recipients. Three of the 4 presented collaborations are either fully operated or led by European countries. This highlights the crucial role of ongoing international cooperation in the development of KPDs, in particular in Europe. By further promoting collaboration among countries, we can facilitate pan-European exchanges and improve access to live kidney transplants for patients in need.

 ...

"A fundamental difference between the programs is their collaboration model. STEP, ANZKX, and the Czech-Austrian-Israeli collaboration operate as “merged pool” model, where all participating pairs are combined for joint matching runs. For STEP and ANZKX, no other matching runs are conducted by partners at any level (hospital or national), whereas in the Czech-Austrian-Israeli collaboration, the Austrian and Israeli partners report performing local exchanges whenever compatible pairs are identified.
 

"In contrast, KEPSAT uses a “sequential pool” model, where national matches are attempted first, and only unmatched pairs are entered into the international pool. It is recognized that the last 2 strategy strategies may lead to a fragmented market, potentially limiting matches for highly sensitized patients, as easier-to-match pairs are removed beforehand."

 It's ironic that a program that appears to be intended primarily to help hard-to-match pairs is organized in a way that limits them in this way.

The paper concludes on an optimistic note (with which I fully agree):

"In conclusion, ongoing international cooperation is essential for advancing KPD programs globally. Expanding cross-border exchanges and improving access to kidney transplants can greatly benefit patients worldwide. Additional strategies, such as NDADs, desensitization protocols, and the inclusion of compatible pairs, can further enhance the effectiveness of both national and international programs. Oversight of these initiatives is crucial to safeguarding the welfare of both donors and recipients, as well as to maximizing the success rates of kidney transplants.
 

"Looking ahead, new initiatives, and projects, funded by international health organizations, such as the European Kidney Paired Exchange Programme project (https://www.hnbts.hu/euro-kep/project), funded by EU4Health and starting in November 2024, aim to expand global collaboration among KPD programs, building on and strengthening existing partnerships. This increased international cooperation is expected to create additional opportunities for patients in need of kidney transplants worldwide, making life-saving transplants accessible to more individuals regardless of their geographic location."

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Earlier: Portuguese transplant docs noted the problem and argued for more global kidney exchange:

Tuesday, March 12, 2024 Kidney exchange between Portugal and Spain, and prospects for global kidney exchange

 ######### 

*Notes on population:

Spain: 49 million; Italy 59 million; Portugal 10 million ; KEPSAT total pop =  approx 118 million

 Australia 28 million; NZ 5 million: ANZKX total pop approx 33 million

Austria: 9 million, Czech Republic  11 million, Israel 10 million: AT-CZ-IL total 30 million

Sweden: 11 million; Norway:  6 million; Denmark 6 million; Finland  6 million: STEP total approx 29 mil

Proposed age-adjusted smoking ban in the U.K.

 The BBC has the story, about a proposal to ban smoking for everyone currently under the age of 18. (What could go wrong?)

What is the UK smoking ban, how will it work and when will it start? By Aurelia Foster, BBC News

"Prime Minister Rishi Sunak effectively wants to ban smoking in the UK.

MPs have voted to back the government's plans to create a "smoke-free generation", and reduce the number of smoking-related deaths.

What is the smoking ban?

The restrictions will apply to the sale of cigarettes in the UK rather than the act of smoking itself.

Under the new law, each year the legal age for cigarette sales - currently 18 - will increase by one year.

It means that people born in or after 2009 will never be able to legally buy cigarettes, leading to an effective ban.

The law will not affect those who are allowed to buy cigarettes now.

To crack down on under-age sales, the government says it will introduce £100 on-the-spot fines for shops in England and Wales which sell tobacco and vapes to under-age people.

Local authorities will retain the proceeds to reinvest into enforcement of the law.

This would be on top of £2,500 fines that courts can already impose.

The government says it will spend £30m on enforcement, which will include tackling the availability of cigarettes on the black market.

The new rules will apply in all duty free shops in the UK, but anyone buying cigarettes abroad would be able to bring them back to the UK as long as they were legally acquired elsewhere.

The government aims to have the new system in force by 2027.

Mr Sunak wants to work with the governments of Wales, Scotland and Northern Ireland to introduce the legislation across the UK."

HT: Oğuzhan Çelebi

#######

Earlier: 

Thursday, March 14, 2024

New Zealand repeals anti-smoking law that would have prevented tobacco sales to anyone born after 2008

New Zealand repeals anti-smoking law that would have prevented tobacco sales to anyone born after 2008

 In an earlier blog post, I wrote about a New Zealand anti-smoking law, saying "And now there's a law that cuts nicotine content of cigarettes, and (get this) "bans the next generation of New Zealanders — anyone born after 2008 or currently 14 years old or younger — from ever buying cigarettes in the country. " (That's going to be a complicated age restriction to administer in, say, 10 years from now...)  

Well, people born in 2008 are turning 16 this year, and New Zealand just repealed that law, for reasons that New Zealand's prime minister Christopher Luxon says include concerns about black markets.

Here's an article from Medpage today, reporting on the change in the law. However the article takes the point of view that black markets are just a smokescreen thrown up by tobacco companies.

Up in Smoke: What Happened to New Zealand's Tobacco Ban Plan?— It appears the new government is making an embarrassing attempt to fend off a budget shortfall. by Eric Trump, March 6, 2024

"As part of the newly elected coalition government's rush to tick 49 "actions"  off its 100-day list by March 8, it has repealed  the Smokefree Environments and Regulated Products Amendment Act of 2022. This act, passed by the previous Labour government, would have banned selling tobacco products to those born on or after January 1, 2009, reduced the nicotine in tobacco products to non-addictive levels, and slashed the number of outlets allowed to sell tobacco by 90%, from 6,000 to 600. Overall tobacco use was predicted to drop from the current 8% to lower than 5% by 2025, and the act was expected to create a tobacco-free generation.

...

"Why would New Zealand's new coalition government, an alliance opens in a new tab or window

of the conservative National Party along with the libertarian ACT and populist New Zealand First parties, repeal data-driven and life- and money-saving legislation? Without a shred of evidence, Prime Minister Christopher Luxon and his coalition partners have repeatedly claimed restricting tobacco and reducing nicotine levels is experimental (as though that were a bad thing), leading to black marketsopens in a new tab or window and a proliferation of crimeopens in a new tab or window. ACT's health spokesperson Todd Stephenson, for example, said thatopens in a new tab or window the "radical prohibitionism" of creating a smoke-free generation would "push smokers into the arms of gang members."

"This rhetoric uncannily echoes the tobacco lobby. Public health experts at the University of Otago recently released a damning reportopens in a new tab or window showing that the coalition government's arguments in favor of a repeal closely mirror the tobacco industry's own narratives on this subject.

"So suspicious are the similarities between the flimsy remarks of coalition partners and tobacco companies' talking points that the report's authors are calling on all members of parliament to declare any past associations with tobacco companies.

######

 

Here's the story about the Prime Minister's concerns, from Radio New Zealand (RNZ):

Smokefree legislation would have driven cigarette black market - Christopher Luxon

Nicotine in New Zealand, banned for the future generation.

 In New Zealand, the incidence of smoking is down, but not so much among the Maori. And now there's a law that cuts nicotine content of cigarettes, and (get this) "bans the next generation of New Zealanders — anyone born after 2008 or currently 14 years old or younger — from ever buying cigarettes in the country. " (That's going to be a complicated age restriction to administer in, say, 10 years from now...)

NPR has the story:

It's one of the world's toughest anti-smoking laws. The Māori see a major flaw  by Simar Bajaj

"In 2011, New Zealand set one of the most audacious public health targets in the world: to slash its cigarette smoking rate to 5% by 2025.

"The rate was 18% at the time. Fast forwarding over a decade later, the country seems on track to reach this goal ahead of the 2025 target — but only for its European and Asian populations. Māori, on the other hand, had the country's highest smoking rate at 20% in 2021, and they are expected to reach the 5% goal only 40 years later in 2061 per government modeling.

...

"Every year, 4,000 Māori die in New Zealand, and cigarettes are responsible for nearly a quarter of these deaths, according to an estimate in The New Zealand Medical Journal. The study also found that smoking explains a third of the seven-year life expectancy gap between Māori and other New Zealanders.

...

"Last December, in an all-hands-on-deck effort to get Māori across the 2025 finish line, New Zealand passed one of the strongest anti-tobacco laws in global history.

"Specifically, the legislation limits the amount of nicotine in cigarettes to non-addictive levels and reduces the number of retailers allowed to sell cigarettes from 600 currently to 60 by July 2024.

"Most remarkably, the law bans the next generation of New Zealanders — anyone born after 2008 or currently 14 years old or younger — from ever buying cigarettes in the country. "The denicotinization and retail reduction are important for us to get to the lower than 5% smoking rate," says New Zealand's Health Minister Ayesha Verrall, "and then the smoke-free generation policy is to keep us there."

...

"Fears that the crackdown on smoking will backfire

"Tobacco regulation is like a game of whack-a-mole: Knock a product out of one market, and it'll usually pop up in another possibly illegal transaction. In 2019, illicit tobacco represented almost 12% of New Zealand's consumption, and this new legislation may further relegate tobacco to the black market, according to Māori physician and Parliament member Shane Reti, who has tribal affiliations to Ngā Puhi, Ngāti Wai, Ngāti Hine and Ngāti Kura. What he's particularly concerned about is that, given high rates of tobacco addiction in his community, this expanded black market will disproportionately impact Māori via more dangerous cigarettes and police crackdowns.

...

"The risk of such smuggled tobacco, Reti points out, is that it would exist wholly outside New Zealand's safety regulations. As such, he posits that these cigarettes would be more addictive and toxic for Māori who continue to smoke, with higher levels of nicotine and heavy metals like lead. (It is presently illegal to import tobacco into New Zealand without a permit.)

"On the supplier side, organized crime syndicates, which are responsible for large-scale cigarette smuggling, may also surge. "We have some of the highest cost of living and the highest inflation we've had in decades in New Zealand," Reti says, "and what we know is that vulnerable groups who are desperate turn to crime." Given New Zealand's incarceration rates — over half of prisoners are Māori despite representing only 17% of the country — Reti worries that an invigorated black market will lead to a disproportionate crackdown in his community and an even higher percentage of Māori prisoners.

...

"Reti is also concerned about the economic impact on New Zealand's dairies because the anti-tobacco legislation reduces the number allowed to sell cigarettes by 90%. (Dairy is the term New Zealanders use for neighborhood convenience stores.) That might be problematic because tobacco makes up a substantial proportion of dairies' revenue, with estimates ranging from 14% to 47%. If dairies can't find other ways to increase sales, this policy "will almost decimate the small retailers, those small corner dairies," says Reti.

...

"But just as he isn't concerned about the black market, Waa thinks these economic arguments are similarly overblown. "This is my conspiracy hat on, but we suspect that a lot of these arguments are put up by the tobacco industry" to keep their product in stores. Waa points to how dairy owners submitted some 1,000 complaints to the government, all of them following a single template. In any case, Waa has little sympathy for retailers insisting on selling tobacco "because they're making money out of my people dying."

#######

Related earlier post:

Friday, March 24, 2023

Alcohol and race in Australia

Surrogacy law under review in New Zealand

 From the U. of Canterbury:

Who are my parents? Why New Zealand’s ‘creaky’ surrogacy laws are overdue for major reform by Debra Wilson, Annick Masselot,  and Martha Ceballos 

"several separate pieces of legislation cover the two types of surrogacy: gestational, where the child is not genetically related to the surrogate parent; and traditional, where the child is genetically related.

The resulting legal confusion is now the subject of a Law Commission review, which proposes significant reform based on the guiding principle that “the best interests of the child should be paramount”.

Right now, that cannot be said of the way surrogate children and their parents are treated under law that even judges have described as “creaky” and “inadequate”.

 ...

Surrogacy is regulated through the Human Assisted Reproductive Technology Act, which prohibits commercial surrogacy and requires gestational surrogacy to be approved by an ethics committee.

But that act is silent on the legal parentage of the child, leaving this to be determined by the Status of Children Act. Effectively, the woman who gives birth and her partner (if the partner consents to the assisted reproduction) are the child’s legal parents.

This means the intended parents have no legal rights to the child – even if they are the genetic parents – until they adopt the child under the Adoption Act.

But legal parentage is important. Legal parents transfer citizenship to their children and act on their behalf, such as giving consent to medical treatment or travel."

The market for chicken parts

 Can the wholesale food market come to resemble the modern retail financial market?  The WSJ has the story.

Trading Chicken Feet Is Going Digital. For giants like Tyson, moving millions of pounds of meat from farmers to vendors still requires phone calls, spreadsheets and middlemen  By Julia-Ambra Verlaine

"For agricultural giants like Tyson Foods Inc., moving millions of pounds daily of meat and poultry products from farmers to vendors world-wide still requires phone calls, spreadsheets and personal relationships with middlemen who take a cut. Brokers fees can add up, and it is hard to get reliable up-to-the-minute pricing information. Unlike other markets, inventory and supply aren’t available on a centralized database.

...

"Scott Spradley, chief technology officer at Tyson, the second-largest processor of chicken, beef and pork in the U.S., said large transactions with some external partners still require a fax machine. To fill a supermarket order for chicken, salespeople need to call warehouses peppered across the country. Improving the technology could ultimately bring down the cost of processing and distributing food across the country.

...

"The more middlemen involved, the higher the cost. Before a steak ends up on an American dinner table, it goes through slaughterhouses that process and package the meat. While large retailers like Costco Wholesale Corp. or food chains like McDonald’s Corp. have direct contracts with producers at fixed rates, small restaurants and local suppliers have to go through protein brokers including Louis Dreyfus Co., or redistributors such as NebraskaLand.

“It’s an archaic industry that relies on an old-boy network, a bit like foreign exchange in the 1980s,” said Mr. Honey. “We are trying to cut the fat out that brings the price up.”

...

"Companies like Nui, populated with former traders, are seeking to build streaming platforms that centralize supply and give access to smaller players at better prices. Industry publisher Urner Barry is like a Bloomberg in the meat, fish poultry industry—providing data, news and market pricing on lamb, pork, turkey, eggs and more.

"Urner Barry, founded in 1858, upgraded its electronic platform called COMTELL over a year ago. It supplies brokers, restaurateurs and supermarkets with prices on over 15,000 products ranging from chuck roll to West Coast chicken drumsticks.

“Unlike the past, people are coming into this industry that have a finance background,” said Russell Barton, a COMTELL director at Urner Barry. “They are treating the meat and poultry markets like analysts treat the stock market. They aren’t content with a static price sheet.”

***********

One of the companies mentioned in the WSJ story is the New Zealand based Nui (https://www.nuimarkets.com/our-platform/)

New Zealand votes to legalise euthanasia but not marijuana

 The Guardian has the story:

New Zealand votes to legalise euthanasia in referendum--Results must be enacted by the new Labour government by November 2021, but second referendum on legalising cannabis fails to find support  by Eleanor Ainge Roy 

"New Zealanders have voted to legalise euthanasia for those with a terminal illness, in a victory for campaigners who say people suffering extreme pain should be given a choice over how and when to bring their life to a close.

"The decision on whether to legalise euthanasia appeared as a referendum question on the 17 October general election ballot paper, alongside a second referendum question on whether to legalise cannabis – which did not succeed, according to preliminary results.

"The results of the euthanasia referendum are binding and will see the act come into effect 12 months from the final results – on 6 November 2021. Assisted dying will be administered by the Ministry of Health.

...

"The vote makes New Zealand only the seventh country in the world to legalise assisted dying."

Australia-New Zealand kidney exchange program

New Zealand and Australia are cooperating with cross-border, international kidney exchange.

The Australian has the story:
The chain gang
By RICKY FRENCH

"Facilitated by the Organ and Tissue Authority, the Australian and New Zealand Paired Kidney Exchange (ANZKX) has now given 42 people new kidneys since that first operation late last year. While paired kidney exchange has happened in Australia since 2010, this is the first true international collaboration. Eleven chains of operations occurred before Covid-19 stalled things in March, but recruitment into the program continues and there are six surgeries planned in Australia for August.
...
"[Linda] Cantwell is the ­Australian Red Cross ANZKX tissue typing scientist. She’s gatekeeper to the matrix of matches needed to link up potential pairs. There are currently 150 donors and 128 potential recipients in the pool, but for some people only one donor in 10,000 might be suitable. A computer program called OrganMatch runs the algorithms based on each person’s unique antibody profile and tissue typing, and potential matches from up to 300,000 different chains are produced."
************

And here's a related story from Australia's Daily Telegraph:

Organ donation hit hard by COVID-19 global pandemic
by Jane Hansen

"The Australian and New Zealand Paired Kidney Exchange was suspended from March 6 and can only begin if and when travel restrictions lift.

"Deceased kidney and live kidney donor programs across Australia were also suspended from March 24 and only recommenced in May, blowing out waitlists.

"Liver, heart, lung, paediatric and multi-organ transplant programs have continued but are subject to case-by-case review by the National Transplantation and Donation Rapid Response Taskforce, which meets weekly to discuss the response to COVID-19, the Organ and Tissue Authority said.

"According to the latest figures for 2019, the families of 548 loved ones transformed the lives of 1444 Australians by agreeing to organ donation.

"In 2019, 1309 had the potential to be organ donors but just over half of those families agreed."

Double bubble: Locking up with exactly one other household during lock down

You thought your hard interpersonal decisions ended in high school, or when you married?  Not if you live in parts of Canada, where households will now be allowed to expand their social-distancing radius to include exactly one other household.

The WP has the story:

Canadian provinces allow locked-down households to pair up — threatening hurt feelings all around

"While jurisdictions around the world begin to relax their coronavirus restrictions, a handful are pioneering a novel — and potentially fraught — approach: The double bubble.

"There are rules — and they are not for the commitment-phobic. Each household may join with only one other household. Both sides must agree — for better, for worse — to a mutually exclusive relationship. The decision applies to all members of both households. And it’s final.
...
"The arrangement isn’t unique to Newfoundland and Labrador. New Brunswick has also introduced it. So has New Zealand. And the English Channel island of Guernsey.

Organ donor compensation in New Zealand

Organ donation is being reorganized in New Zealand:
First step toward more life-saving organ transplants
Wednesday, 13 March 2019, Press Release: New Zealand Government

"The Organ Donors and Related Matters Bill introduced today enables the New Zealand Blood Service to take on the role of a national organ donation service. The Bill also extends in certain situations, the financial compensation for qualifying donors while they recuperate.
...
“The Bill also amends the Compensation for Live Organ Donors Act 2016, which gives qualifying donors financial compensation while they recuperate.

“While the Act is largely working well, donors who return to work part time are not eligible, nor are donors who could be part of the proposed trans-Tasman kidney exchange. The Bill will amend the Act to allow for compensation in these situations,” David Clark said.

"In 2018, there were 62 deceased donors who enabled 192 recipients to receive kidney, liver, lung, heart or pancreas transplants, and many more recipients received tissue transplants. There were also 84 live donor kidney transplants and 2 live donor liver transplants."