Showing posts with label nondirected donor. Show all posts
Showing posts with label nondirected donor. Show all posts

Friday, February 23, 2024

Directed and semi-directed living donation of kidneys: a current debate in Israel and elsewhere

 Israel leads the world in per capita living kidney donation. A good part of that comes from the work of Matnat Chaim (gift of life), an organization of religious Jews, who donate kidneys to people they don't know.  They are "semi-directed" rather than non-directed donors, in that the organization allows them to indicate some criteria they would like their recipients to have.  Sometimes they want their recipients to be fellow Jews, and this has generated some controversy in Israel.

Below is a study of this phenomenon, and in an accompanying editorial, a criticism of it.

Nesher, Eviatar, Rachel Michowiz, and Hagai Boas. "Semidirected Living Donors in Israel: Sociodemographic Profile, Religiosity, and Social Tolerance." American Journal of Transplantation (in press).

Abstract: Living kidney donations in Israel come from 2 sources: family members and individuals who volunteer to donate their kidney to patients with whom they do not have personal acquaintance. We refer to the first group as directed living donors (DLDs) and the second as semidirected living donors (SDLDs). The incidence of SDLD in Israel is ∼60%, the highest in the world. We introduce results of a survey among 749 living donors (349 SDLDs and 400 DLDs). Our data illustrate the sociodemographic profile of the 2 groups and their answers to a series of questions regarding spirituality and social tolerance. We find SDLDs to be sectorial: they are mainly married middle-class religious men who reside in small communities. However, we found no significant difference between SDLDs and DLDs in their social tolerance. Both groups ranked high and expressed tolerance toward different social groups. Semidirected living donation enables donors to express general preferences as to the sociodemographic features of their respected recipients. This stirs a heated debate on the ethics of semidirected living donation. Our study discloses a comprehensive picture of the profile and attitudes of SDLDs in Israel, which adds valuable data to the ongoing debate on the legitimacy of semidirected living donation.


Danovitch, Gabriel. "Living organ donation in polarized societies." American Journal of Transplantation, (Editorial, in press).

"Nesher et al are to be congratulated for reporting on a unique, effective, yet ethically problematic manifestation of living kidney donation in Israel. To summarize, living kidney donation has become “de riguer,” a “mitzvah” (a religiously motivated good deed) among a population of mainly orthodox Jewish men living in religiously homogenous settlements. According to the authors, the donors view themselves as donating altruistically within a larger family. The donations, over 1300 of them, 60% of all living donations in the country, have changed the face of Israeli transplantation, reduced the waiting time for all transplant candidates on the deceased donor waiting list,2 and minimized the temptation of Israeli transplant candidates to engage in “transplant tourism,” a phenomenon that was an unfortunate feature of Israeli transplantation before the passage of the Israeli Transplant Act of 2008 that criminalized organ trading.3

So, what’s the problem? Matnat Chaim (“life-giving”), the organization that facilitates the donations, permits the donors to pick and choose among a list of potential recipients using criteria that according to its own website,4 and as Nesher et al note,1 are not transparent. ... frequently the donors elect to donate to other Jews.  ... " Israel is a country with an 80% Jewish majority; a decision to only donate to other Jews, thereby excluding non-Jews, is a practice that, were it reversed in a Jewish minority country, would likely be labeled antisemitic. Concern that the process encourages racist and nationalistic ideation has been raised in the past6 and only emphasized by the public pronouncement of some media-savvy kidney donors.7

"What lessons does the Israeli experience hold for the US and other countries, faced as all are, with a shortage of organs for transplant? Conditional living donation exists to a limited extent in the US: DOVE is an organization that works to direct living kidney donation to US army veterans9; Renewal is an organization that encourages and facilitates living donation from Jews to other Jews but also to non-Jews10; in the 1990s an organization called “Jesus Christians” made organ donation one of its precepts.11 But in each of these cases, it is a minority group whose interests are being promoted.

...

"What now for Matnat Chaim? Given its prominent impact on Israeli transplantation, its allocation policies must be transparent and subject to public comment. Criteria must be medical in nature and religious or political considerations excluded. Fears that as a result living kidney donation rates will plummet are likely exaggerated. "

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I can't help reading this discussion while being very aware that Dr. Danovitch is an ardent opponent of compensating kidney donors, for fear that inappropriate transplants would take place if that were allowed.  In much of that discussion, inappropriateness of transplants focuses on possible harm to the (paid) donors, but the donors in the Israeli case are unpaid. Here his concern is that donor autonomy about to whom to give a kidney comes at the expense of physician autonomy in choosing who should receive a transplant, by "medical" criteria. But frequently those criteria have a big component based on waiting time, rather than any special medical considerations. So maybe in general he thinks that privileging the physician's role in this way is worth having fewer organs and consequently more deaths.

Still, I think he has a point about how we perceive what is repugnant. Having minority donors donate to fellow minority recipients seems much less repugnant than having majority donors specify that they aren't interested in donating to minority recipients.

But, speaking of donor autonomy, I'm not sure that there are practical ways around it, since semi-directed donors could always present as fully directed donors to a particular person that some organization had helped them find. So, we may just have to live with the increase in donations and lives saved that donor autonomy can support.

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Earlier posts:

Thursday, July 27, 2023

Kidney brouhaha in Israel: is a good deed still good when performed by a shmuck?


I ended that post with this:

"I'll give the last word to a Haaretz op-ed, also in English:


Monday, July 31, 2023

Altruistic kidney donors in Israel


...
and, here in the U.S.:

Friday, March 12, 2021

Kidneys for Communities

" A new organization, Kidneys for Communities, plans to advocate for living kidney donation by seeking donors who identify with a particular community.  Their come-on is "Put your kidney where your heart is.  Share your spare with someone in your community"

Wednesday, February 21, 2024

Nondirected living kidney donors--Abundant (the movie, in progress)

 Abundant is a movie in the making,  a documentary about altruism, focused on non-directed living kidney donors, who start kidney exchange chains. It isn't done yet, but now they are in the editing process...

"Abundant is a feature-length documentary film about the complex, human experience of giving.  To fully understand giving, Abundant enters the world of extreme altruism.  And there are no more extreme altruists than non-directed living kidney donors.  These rare individuals give a kidney away to a complete stranger.  It’s all risk, no reward.  Or is it? 

"Abundant features true stories of non-directed kidney donors recorded live on stage at the performance art show CrowdSource for Life.  Their stories illustrate the unimaginable impact of extreme giving.  It’s obvious their kidney donations saved another person’s life, but there is so much more involved.

"Insights from experts from the worlds of economics, spirituality, business, the arts, psychology and neuroscience, frame and explain the altruistic psyche. In his interview for Abundant, Buddhist monk Bhante Sujatha described giving with a literal translation from his Sri Lankan language, Sinhala.  In Sinhala, giving means, “It leaves my hand.”  That’s a clear, simple and elegant concept.  Yet so many of us struggle with the genuine act of giving and the abundance required to give openheartedly.

"Through stories, commentary and experiences, Abundant explores how our culture struggles with abundance and what we can do to become more altruistic as a community."

#####

Update: here's a link to join the email list for updates on the movie:  https://abundantmovie.com/

Monday, July 31, 2023

Altruistic kidney donors in Israel

 The Forward has the story

Why Israel has more altruistic kidney donors than any other country in the world By Michele Chabin

"Israel is in the bottom half of countries when it comes to organs harvested after death, the type used in most transplants globally. ...

"But ...for more than a decade the number of Israelis who have donated kidneys while they are still alive and well has increased to the point that Israel is the worldwide leader in live donations per capita.

"That’s in large part thanks to the Jerusalem-based nonprofit ... Matnat Chaim, Hebrew for “gift of life,” which recruits and encourages individuals in good health to donate a kidney for purely altruistic reasons. 

"Of the more than 1,450 live kidney donations Matnat Chaim has facilitated, more than 80% percent were altruistic – donated by individuals who had no connection to the recipient. According to the group’s records, it made at least half of the matches between recipients and live donors in Israel from 2015 to 2022.

"Rabbi Yeshayahu Heber, whose life was saved by kidney from a live donor, founded Matnat Chaim in 2009 with his wife Rachel. Rabbi Heber, who died from COVID-19 in April 2020, had said he was moved to recruit volunteer donors after watching other kidney patients die for lack of transplants. 

"On Israel Independence Day this spring, Rachel Heber was awarded the prestigious Israel Prize in honor of the couple’s lifesaving work. 

...

Broadly speaking, the medical definition says that death occurs when the brain is no longer functioning, even if the heart is still beating. There are exceptions, but most ultra-Orthodox rabbis say death occurs when the heart stops beating and the person stops breathing.

“The problem is, if you wait until the heart stops, you can’t harvest the organs,” said Judy Singer, Matnat Chaim’s assistant director.

"For these reasons, Heber made it his mission to recruit live kidney donors.

"With other groups, including the Halachic Organ Donor Society and the Israel Transplant Authority, Matnat Chaim has convinced many religious Jewish communities to encourage members to donate altruistically. “Today, religious Jews, and haredim especially, are at the forefront of live kidney donations,” Singer said. “They say, I can’t donate an organ after death, but take my kidney and help someone now.”About 90% percent of Matnat Chaim’s kidney donors belong to the Modern Orthodox or ultra-Orthodox streams of Judaism.

“That number used to be 97%, but we’re always looking to increase the number of secular donors and Arab donors,” Singer said.

"The group has arranged for “many” Arab Israelis to receive transplants, she said, but did not share numbers for those recipients. Matnat Chaim is looking to work with an Arab group or individual to increase the number of Arab donors and recipients in the future, she added.

...

"According to the Ministry of Health, 656 transplants were carried out in Israel in 2022. Of those about half — 326 — came from living donors. By comparison in the U.S. that same year, about 15% of all organ donations came from living donors.

"Though transplant rates have been rising in both countries, many are still dying for lack of a donor. In Israel, 77 people died waiting for one in 2022."

 

Tuesday, July 11, 2023

NYC police officer receives a kidney through Kidneys for Communities (KFC:)

 Police magazine has the story of an anonymous living kidney donor who wanted his/her kidney to go to a first responder, facilitated by  Kidneys for Communities.

NYPD Officer Received Kidney Transplant with Aid of Nonprofit Group and PBA. Kidneys for Communities' Kidneys for First Responders initiative is designed to improve access to and facilitate living kidney donations by connecting those who want to help first responders with those who are in need of a lifesaving kidney donation.  July 7, 2023

"Kidneys for Communities, a national community-directed living kidney donation program, launched its Kidneys for First Responders initiative with its first kidney transplant recipient, New York City Police Officer Melissa Quinones, with assistance from the Police Benevolent Association of the City of New York.

******

And here's the KFC press release (doesn't that acronym already sound familiar?):

Kidneys for Communities Announces their ‘Kidneys for First Responders’ Initiative

"Kidneys for Communities’ Kidneys for First Responders initiative is designed to improve access to and facilitate living kidney donations by connecting those who want to help first responders with those who are in need of a lifesaving kidney donation"

"As Dr. Lloyd E. Ratner, who performed Quinones’ transplant, affirms, “The community-directed model, now available to interested communities and pioneered by Kidneys for Communities, is a common-sense approach to growing the pool of living kidney transplant donors. As more communities come on board, we expect it will shorten the critical waiting time for transplant recipients and save lives.”."

Monday, July 10, 2023

Compensating kidney donors: a call to action by Brooks and Cavanaugh in the LA Times

 Here's a clarion call for compensation of living kidney donors, from two nondirected kidney donors.  It's not the first, and very likely not the last, given the difficulty of modifying the existing law.  But it makes the case very clearly (and proposes that a tax credit spread over ten years might be the way to move foreward).

Opinion: A single reform that could save 100,000 lives immediately BY NED BROOKS AND ML CAVANAUGH, JULY 9, 2023 

"Never in the field of public legislation has so much been lost by so many to one law, as Churchill might’ve put it. The National Organ Transplant Act of 1984 created the framework for the organ transplant system in the United States, and nearly 40 years later, the law is responsible for millions of needless deaths and trillions of wasted dollars. The Transplant Act requires modification, immediately.

"We’ve got skin in this game. We both donated our kidneys to strangers. Ned donated to someone who turned out to be a young mother of two children in 2015, which started a chain that helped an additional two recipients. And Matt donated at Walter Reed in 2021, after which his kidney went to a Seattleite, kicking off a chain that helped seven more recipients, the last of whom was back at Walter Reed.

"Ned founded, and Matt now leads, an organization that represents nearly 1,000 living donors

...

"eight years ago, when Ned donated, the number of living kidney donors was 6,000. With all the work we’ve done since, the number of living donors is still about 6,000 annually. In the United States, nearly 786,000 people suffer from end-stage kidney disease, more people than can fit in the 10 largest NFL stadiums combined.

...

"More Americans die of kidney disease than of breast or prostate cancer, and one in three of us is at risk. This illness is widespread, but what makes it worse is the staggering financial burden borne by everyone. The head of the National Kidney Foundation testified in March that Medicare spends an estimated $136 billion, nearly 25% of its expenditures, on the care of people with a kidney disease. Of that, $50 billion is spent on people with end-stage kidney disease, on par with the entire U.S. Marine Corps budget.

...

"The National Organ Transplant Act prohibits compensating kidney donors, which is strange in that in American society, it’s common to pay for plasma, bone marrow, hair, sperm, eggs and even surrogate pregnancies. We already pay to create and sustain life

...

"The ethical concerns regarding compensation are straightforward. Nobody wants to coerce or compel those in desperate financial straits to do something they would not have done otherwise. The challenge, then — until artificial or nonhuman animal substitutes are viable options — is to devise a compensation model that doesn’t exploit donors.

"Compensation models have been proposed in the past. A National Institutes of Health study listed some of the possibilities, including direct payment, indirect payment, “in kind” payment (free health insurance, for example) or expanded reimbursements. After much review, we come down strongly in support of indirect payment, specifically, a $100,000 refundable federal tax credit. The tax credit would be uniformly applied over a period of 10 years, in the amount of $10,000 a year for those who qualify and then become donors.

"This kind of compensation is certainly not a quick-cash scheme that would incentivize an act of desperation. Nor does it commoditize human body parts. Going forward, kidney donation might become partly opportunistic rather than mostly altruistic, as it is now. But would it be exploitative? Not at all."

...

Ned Brooks and ML Cavanaugh are living kidney donors, and Brooks is the founder of the Coalition to Modify NOTA.

********

Here are all my posts that mention Ned Brooks, starting with this one:

Friday, February 26, 2016

Saturday, January 14, 2023

The power of kidneys, altruism, and books. (And recommendation of a doctor in the UK)

 Here's a story, about kidneys and about books, in inews.co.uk:

‘It’s a gift with no conditions attached’: Why I donated my kidney to a person I’ll never meet. 250 people die each year in the UK because there are not enough kidneys available. So when GP Richard Armitage discovered altruistic donation was possible, he gave away an organ. By Tom Ough

"Despite being a GP, Richard Armitage had spent most of his career unaware that altruistic donations were possible. In this respect, Armitage, 34, was like many of his colleagues in the medical profession. That changed in 2017. Armitage, visiting the Nobel Laureate Museum Stockholm, bought a book by Alvin Roth, an economist who won a Nobel Prize in 2012. The book was Who Gets What — and Why: The New Economics of Matchmaking and Market Design, and in it Roth wrote how we allocate things within markets that aren’t dictated by money.

"Examples include the allocation of children to schools, doctors to hospitals, and kidneys to people with end-stage renal disease. Roth discussed what is known as non-directed altruistic kidney donations – in short, kidneys donated to strangers. Sitting on the plane home, Armitage read the book with fascination. When he returned to Nottingham he checked the NHS website to see whether non-directed altruistic kidney donation was possible in the UK. It was.

...
"In 2018 altruistic donors began being routinely added to the UK Living Kidney Sharing Scheme (UKLKSS), which oversees this sharing of organs by living donors. Apparently as a result of the move, in 2019 there was a 60 per cent rise in altruistic donations – from 124 to 183. Twenty-eight per cent of kidney transplants are now from living donors.
...
"It seemed a good application of the kind of moral philosophy that Armitage had discovered the same year, 2017, when he read Famine, Affluence and Morality. It is an influential essay in which Peter Singer, an Australian philosopher, argued that the West should be donating far more resources to humanitarian causes.
...
"All of Armitage’s intellectual discovery, including his reading of Roth’s writing on kidney donation, happened in one year, 2017 – also the year that Armitage finished his GP training. It marked the end of “a 10-year head-down slog” that began with the first day of medical school. “After I passed my last exam, it felt like I finally lifted my head up and asked: ‘But why am I doing this?’”

"And so Armitage’s first conversation with his regional kidney transplant centre was followed by an appointment with a Living Donor Nurse, who explained what donation would entail: the testing, the preparation, the surgery. Armitage was invited to speak to his loved ones and consider whether he was ready; it turned out he wasn’t.

"There were several hold-ups. At first, Armitage felt the beginning of his GP career was the wrong time to take weeks off work. Then Covid stalled the NHS’s kidney-sharing scheme. Armitage still wanted to donate his kidney, and successfully underwent a battery of investigations: a renal tract ultrasound scan, an electrocardiogram, chest X-ray, various fasted blood tests, and an X-ray of his kidney. As per the requirements of the donation scheme, Armitage met a clinical psychologist to discuss his state of mind, put the psychologist in touch with a loved one in order to independently assess his state of mind, and met a representative of the Human Tissue Authority to ensure that he was not donating his kidney under duress or for financial gain.
...
"Armitage spent several weeks in Ukraine as part of his work for the charity UK-Med, which sent British medics to deliver emergency healthcare. “That obviously meant I couldn’t continue with the donation process,” he says with some understatement. But when he got home, he told the donor team he was ready. “Can we crack on?”, he asked.

"The operation was on 23 November. Everything was in place; Armitage was part of a chain on which three people with end-stage renal disease were due a kidney.
...
"And just before he was discharged – three days after surgery, having convinced the hospital staff he was ready to take care of himself – he was informed that all the recipients in the chain now had working kidneys. “That was a very meaningful moment that made it all worthwhile,” says Armitage."

Sunday, December 4, 2022

It's not so easy to become a living kidney donor: report from the Cleveland Clinic

 It's not so easy to become a living kidney donor.  Here's a report on the pipeline at the Cleveland Clinic:

Cholin, Liza K., Jesse D. Schold, Med MStat, Susana Arrigain, Emilio D. Poggio, John R. Sedor, John F. O’Toole, Joshua J. Augustine, and Alvin C. Wee. " Characteristics of Potential and Actual Living Kidney Donors: A Single Center Experience, Transplantation (2022).


It's concerning to see that 164 donor candidates were rejected at this center for being "ABO or crossmatch incompatible."  Were they told about the possibility of kidney exchange?


 

"There was a mean of 2.8 and median of 1 (1, 3) potential donors for every 1 transplant candidate that did not receive a kidney. There was a mean of 5.9 and median of 2 (1, 5) potential donors for every 1 transplant candidate that received a kidney."


HT: Frank McCormick

Saturday, October 15, 2022

Kidney exchange in The Times of India

 The Times of India covers my talk at the Indian Society of Transplantation meeting:

Alvin Roth for legal boost to kidney exchange pool in India by Chaitanya Deshpande, Oct 15, 2022c

 The site makes it hard to extract text, but here's a photo of some comments, which make me hope that some action may be taken:


Update: 





Saturday, September 17, 2022

Non-directed organ donors and NLDAC financial support

For some years I've been a member of the advisory group of the National Living Donor Assistance Center (NLDAC) which is authorized to offer federally funded financial support (for travel, and now also for lost wages and childcare expenses) to needy donors whose recipients also cannot afford to offer such support. As kidney exchange has grown, so have the number of non-directed donors, who don't have a particular recipient in mind. In a recent email, NLDAC has defined how these donors can qualify for financial assistance.

"Defining Non-Directed Donors

"Eligibility for NLDAC depends primarily on the recipient's household income. This is because the Organ Donation and Recovery Improvement Act requires NLDAC to assess the recipient's ability to reimburse their donor before providing reimbursement with federal funding. Most donors have a particular recipient in mind, and that person is allowed to reimburse their expenses, if they are willing and able to do so. NLDAC provides reimbursement when the recipient cannot afford to provide it. Some donors do not have a recipient to ask for help, though. A non-directed donor is a living donor with no intended recipient. These donors can apply to NLDAC without recipient information because there is no identified recipient. Non-directed donors are eligible for NLDAC regardless of their eventual recipient's information, as long as the donor meets the residency requirements and applies on time. 

"Let's consider some examples:

"Tina heard on the news that there are 5,000 people waiting for a kidney transplant in her state. She called a transplant center and asked that they give her kidney to anyone who needs it, if she is approved to donate. Tina is a non-directed donor because she has no intended recipient. 

"Anthony read about a stranger's search for a living kidney donor on Facebook. Though he doesn't know the person, he would like to be evaluated as a potential donor for them. He is a directed donor because he has an intended recipient, even though he doesn't know them personally. 

"Jacqueline wants to donate to a member of her church without revealing her identity to the recipient. She is a directed donor because she has an intended recipient, though she wants to remain anonymous. 

"Esther wanted to donate to her husband, but they are not a good match. Through kidney paired donation, she donates to a stranger, and the stranger's loved one donates to her husband. Because Esther has an intended recipient who received a transplant through her donation, she is a directed donor. 

"Devin was being evaluated as a potential living donor to his uncle when his uncle received a deceased donor transplant. Devin decided he was still willing to donate even though his uncle no longer needed his organ, and asked the transplant center to give his kidney to anyone on the waitlist. Devin is now a non-directed donor because he does not have an intended recipient anymore. 

"Which of these donors can apply to NLDAC without their recipient's information? Tina and Devin, because they are donating without an intended recipient. Anthony, Jacqueline, and Esther can apply with their intended recipient, and NLDAC will keep the donor and recipient's information private. Esther would apply with her originally intended but incompatible recipient, her husband."

************

All my posts on NLDAC:  https://marketdesigner.blogspot.com/search?q=nldac&max-results=20&by-date=true


Thursday, September 8, 2022

Three living kidney donors talk about their experience

 Tonight at 6pm Eastern, three donor stories from the National Kidney Donation Organization (NKDO)



Click Here to Register

Monday, August 8, 2022

Renewal: "My donor wanted to give me her kidney — and get home in time for Shabbat"

 When reporter Stewart Ain needed a kidney transplant, he contacted Renewal. He explains the process that led to him being matched to an altruistic donor and transplanted.

My donor wanted to give me her kidney — and get home in time for Shabbat  By Stewart Ain

"Two months later, my wife Meryl and I were sitting in Renewal’s office speaking with Rabbi Josh Sturm, Renewal’s director of outreach, and Miriam Lefkowitz, Renewal’s kidney coordinator. We were told to reach out to friends, relatives, neighbors — everyone we knew — and ask them to listen to an online presentation the rabbi would make about what kidney donation entails and how it literally gives the recipient a new life. 

"As we walked out the door, the rabbi said they had found that if at least 200 people listened to the presentation, the odds were very good a donor would be found. And the donor would not necessarily be someone actually listening online but often from the advance publicity the presentation would generate.

"Renewal created a flier for us with information about the upcoming presentation. At my request, several synagogues posted it on their websites, a couple of Jewish weekly newspapers ran it each week, and Hadassah Magazine featured my story in an article about kidney transplants. One of the three synagogues we belong to contacted the NBC station in West Palm Beach, Florida. The station’s reporter interviewed both me and one the synagogue’s rabbis. A story about my need for a kidney was on the evening newscasts.

"The presentation took place during the 10 days between Rosh Hashanah and Yom Kippur last fall. More than 250 computers tuned in. In the following days I learned that several people had asked Renewal for the nasal-swab kit needed to see if they were a match for me. Later, I heard from several friends and relatives that they had been disqualified as donors for various reasons. "

His donor may not have been one of those who had heard the presentation about his case.

"The idea of donating one of her kidneys surfaced again last Hanukkah when someone mentioned that their daughter had just donated a kidney through Renewal. She contacted the organization in November, and three days later received a swab kit. On Jan. 17, a rabbi from Renewal called and asked if she was still interested in donating. When she said yes, she was told she was a match for two people.

“I remember saying, `I’m not going to play God, let whoever is a better match have it,” she said."

Both patient and donor are doing well.

Sunday, March 13, 2022

Nondirected living liver donation in the U.S.

Nondirected kidney donation has been important in U.S. kidney transplants for some time.  Here's a report observing that nondirected living liver donation is picking up.

 Herbst, Leyla R. BA1; Herrick-Reynolds, Kayleigh MD1,2; Bowles Zeiser, Laura ScM1; López, Julia I. BA1; Kernodle, Amber MD, MPH1; Asamoah-Mensah, Awura1; Purnell, Tanjala MPH, PhD2; Segev, Dorry L. MD, PhD1,3,4; Massie, Allan B. PhD, MHS1,3; King, Elizabeth MD, PhD1; Garonzik-Wang, Jacqueline MD, PhD1; Cameron, Andrew M. MD, PhD1 The Landscape of Nondirected Living Liver Donation in the United States, Transplantation: March 2, 2022 - doi: 10.1097/TP.0000000000004065 

"Living donor liver transplants (LDLTs) including those from nondirected donors (NDDs) have increased during the past decade

...

"NDDs increased from 1 (0.4% of LDLTs) in 2002 to 58 (12% of LDLTs) in 2020. Of 150 transplant centers, 35 performed at least 1 NDD transplant.

...

"Liver NDD transplants continue to expand but remain concentrated at a few centers. Graft distribution favors female adults and pediatric patients with biliary atresia. Racial inequities in adult or pediatric center-level NDD graft distribution were not observed."

Sunday, March 6, 2022

Kidneys on Kilimanjaro

 The Washington Post has the story

A group of organ donors is climbing Mount Kilimanjaro this week. They each have one kidney.  By Cathy Free

"“We thought, ‘How about if we use this climb to raise awareness and show everyone that you can still lead a healthy and active life if you donate a kidney?’ ” said McLaughlin, a former college soccer coach who lives in Seattle.

“It didn’t take long before we had 22 kidney donors signed up to make the trip,” he said.

"The group hopes the trek, which will begin Friday, will help dispel the notion that donors can’t live full lives with one kidney, said Kidney Donor Athletes founder Tracey Hulick, who donated a kidney to a stranger in May 2017.

...

"The group — which named its adventure the One Kidney Climb — hopes to reach Kilimanjaro’s 19,341-foot volcanic summit at sunrise on March 10, World Kidney Day."

Saturday, December 25, 2021

Advertising, and kidney donation.

The Guardian has the story:

He put up a Times Square billboard in search of a kidney – and saved more lives than his own.  by Joshua Needelman

"Marc Weiner booked one of the world’s most visible advertising spots, hoping his life would change. He ended up changing the lives of dozens of others, too."

Saturday, July 10, 2021

Vouchers in kidney exchange chains: a report of initial experience at NKR

 Here's a report of the experience with kidney vouchers, pioneered at UCLA and the National Kidney Registry. That's a policy that has now spread more widely, in the U.S.  This paper reports data from the NKR for 2014 through January 2021, during which time 250 donors were given vouchers, 6 of which have so far been redeemed. Voucher donors start kidney exchange chains (like non-directed donors) that can later be redeemed by (e.g.) their family members.

Voucher-Based Kidney Donation and Redemption for Future Transplant, by Jeffrey L. Veale, MD1; Nima Nassiri, MD2; Alexander M. Capron, JD2,3; Gabriel M. Danovitch, MD1; H. Albin Gritsch, MD1; Matthew Cooper, MD4,5; Robert R. Redfield, MD6; Peter T. Kennealey, MD7; Sandip Kapur, MD8

JAMA Surg. Published online June 23, 2021. doi:10.1001/jamasurg.2021.2375

"Abstract:

Importance  Policy makers, transplant professionals, and patient organizations agree that there is a need to increase the number of kidney transplants by facilitating living donation. Vouchers for future transplant provide a means of overcoming the chronological incompatibility that occurs when the ideal time for living donation differs from the time at which the intended recipient actually needs a transplant. However, uncertainty remains regarding the actual change in the number of living kidney donors associated with voucher programs and the capability of voucher redemptions to produce timely transplants.

...

Design, Setting, and Participants  This multicenter cohort study of 79 transplant centers across the US used data from the National Kidney Registry from January 1, 2014, to January 31, 2021, to identify all family vouchers and patterns in downstream kidney-paired donations. The analysis included living kidney donors and recipients participating in the National Kidney Registry family voucher program.

Exposures  A voucher was provided to the intended recipient at the time of donation. Vouchers had no cash value and could not be sold, bartered, or transferred to another person. When a voucher was redeemed, a living donation chain was used to return a kidney to the voucher holder.

Main Outcomes and Measures  Deidentified demographic and clinical data from each kidney donation were evaluated, including the downstream patterns in kidney-paired donation. Voucher redemptions were separately evaluated and analyzed.

Results  Between 2014 and 2021, 250 family voucher–based donations were facilitated. Each donation precipitated a transplant chain with a mean (SD) length of 2.3 (1.6) downstream kidney transplants, facilitating 573 total transplants. Of those, 111 transplants (19.4%) were performed in highly sensitized recipients. Among 250 voucher donors, the median age was 46 years (range, 19-78 years), and 157 donors (62.8%) were female, 241 (96.4%) were White, and 104 (41.6%) had blood type O. Over a 7-year period, the waiting time for those in the National Kidney Registry exchange pool decreased by more than 3 months. Six vouchers were redeemed, and 3 of those redemptions were among individuals with blood type O. The time from voucher redemption to kidney transplant ranged from 36 to 155 days.

Conclusions and Relevance  In this study, the family voucher program appeared to mitigate a major disincentive to living kidney donation, namely the reluctance to donate a kidney in the present that could be redeemed in the future if needed. The program facilitated kidney donations that may not otherwise have occurred. All 6 of the redeemed vouchers produced timely kidney transplants, indicating the capability of the voucher program."

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I haven't managed to sign a data use agreement with NKR, because Stanford's policies don't allow researchers to cede editorial control of the final paper to the data owners, which NKR's agreement requires.  See earlier post:

Thursday, March 18, 2021

Friday, May 28, 2021

Kidney to Share book launch, Zoom recording

 Last week I had the pleasure of joining the discussion of the book Kidney to Share  by Martha Gurshun & John Lantos.  It was on Zoom, and the recording is now available here.

Martha and John speak for the first half hour, then I make some remarks for about ten minutes, after which there is an interesting general discussion. The whole thing is an hour, and the recording allows you to hear it at 1x, 1.5x or 2x the original speed...

Tuesday, May 18, 2021

Kidney to Share

 The Stanford Center for Biomedical Ethics is sponsoring a presentation tomorrow of a new book, Kidney to Share.  It's written largely in alternating chapters, by Martha Gershun, an altruistic kidney donor,  and  her friend John Lantos, a doctor and bioethicist who is a member of the same synagogue. I'll join in the discussion.

Kidney to Share Book Launch Seminar  With Authors Martha Gurshun & John Lantos,  Wednesday, May 19, 2 - 3pm PST  (RSVP )

There has been much recent discourse, and some regulatory action, about reducing the financial dis-incentives to being a kidney donor (e.g. steps have been taken to facilitate the reimbursement of out of pocket travel and child care expenses arising from donation, and even replacement of some lost wages).  But this book is among the first discussions I've seen of other dis-incentives to donation, arising from  procedural and logistical barriers.  

In Martha Gershun's case, many of these barriers to donation arose from the fact that the Mayo Clinic, where she donated, was inconveniently far from her home in Kansas City, but Mayo insisted that all procedures and tests be conducted on-site in Rochester, Minnesota. (Some of these barriers have in fact been overcome in kidney exchange, but Ms. Gershun was making a direct donation, to a patient she had read about.)

Dr. Lantos points out that if transplant centers treated kidney donors more like the way they treat financial donors, they would have found ways to smooth some of the logistical barriers that were bureaucratically applied.

Ms. Gershun, in email correspondence with me after I had read the book, wrote:

"I was very interested in your thought that there has been some improvement in logistics over the past 20 years, since it is now easier to ship kidneys.  Many of the barriers I encountered in my efforts to donate were exacerbated because we lived 6 hours from Mayo.  At every stage, they were unwilling to “outsource” any part of the process to another provider (not even that sticky substance abuse appointment or processing the blood that otherwise had to be shipped on dry ice). 

...

"Why couldn’t I have undergone the medical/psychological evaluation and surgery at KU Medical Center, a highly-respected transplant center just 2 miles from my house, with the kidney flown to Mayo for transplantation?  You have made me think that another barrier to consider must surely be the proprietary and siloed nature of Transplant Centers.  How many more transplants could we do if we eliminated the need for both donor and recipient to receive their care at the same institution?  My understanding is that pairs/chains have made a lot more progress on that front than directed donations."

Kidney to Share


In a subsequent email exchange Ms. Gershun points out to me that other transplant centers accept shipped kidneys even for direct transplants from donor to recipient (with no exchange involved). (The article below, from the ABA Journal, concerns a kidney shipped from UCLA to MGH in Boston, where the transplant was performed.  Both of those transplant centers have lots of inter-hospital kidney exchange experience.)

Father and daughter legal scholars complete successful kidney transplant  by Stephanie Francis Ward

"Jennifer Mnookin had one kidney removed in Los Angeles on Dec. 2, and it was put on an overnight flight to Boston to be transferred Dec. 3 to Robert Mnookin, who had end-stage kidney disease. Both are doing well."

Friday, March 12, 2021

Kidneys for Communities

 A new organization, Kidneys for Communities, plans to advocate for living kidney donation by seeking donors who identify with a particular community.  Their come-on is "Put your kidney where your heart is.  Share your spare with someone in your community"

They say "Kidneys for Communities was founded on the idea that communities inherently take care of each other. If we can save a life, we can save the world.

"When we tap in to the compassion and connection of communities, we can radically increase the number of living kidney donors around the world and save tens of thousands of lives every year. By enlisting one community after another to join our mission, more donors will choose to give, more lives will be saved and more communities will be strengthened."

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Here's their press release, which includes the idea of a community member starting a kidney exchange chain that would end with a donation to a community member:

Kidneys for Communities' new program aims to increase living kidney donations impacted by COVID. New national community-directed donation program takes center stage for National Kidney Month

"Tackling the living kidney-donor shortage, Kidneys for Communities, a nonprofit, has launched the first-ever national community-directed donation program to increase the pool of living kidney donors in the United States.

"The pandemic has impacted living kidney donations across the U.S. According to the U.S. Organ Procurement and Transplantation Network (OPTN), living kidney donations in 2020 dropped to just 5,237, the lowest number in just over two decades. 

...

"The Kidneys for Communities model addresses the significant shortage of living kidney donations in the U.S., where more than 100,000 people are in immediate need of a kidney transplant, according to the OPTN. Based on OPTN data, of those who receive kidneys from living donors, approximately 95 percent know or are associated with the donor through their community network.

"The community-directed donation model increases living kidney donations by allowing potential donors who belong to membership-based associations to direct their lifesaving donation to someone—even a potential stranger—based on a community they want to support.

...

"To further increase living donor and recipient matches, Kidneys for Communities partners with leaders in the renal transplantation field, including Alliance for Paired Kidney Donation, which matches willing but incompatible kidney donor and recipient pairs through paired donations.

"Through Kidneys for Communities and Alliance for Paired Kidney Donation, a person can donate their kidney on a community member's behalf, similar to a voucher concept; the member in need is then entered into a pool, where they're matched with a viable donor. This creates a chain that allows for at least two people in need to receive a kidney: the member of the respective community and another recipient in need.

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The program is loosely motivated by some of the faith-based organiztions that have been so successful in recruiting living donors in the U.S. and Israel.

Related posts

Friday, February 9, 2018

Friday, April 24, 2020

Rabbi Yeshayahu Haber (1965-2020), who founded "Gift of Life" kidney donor organization

Rabbi Yeshayahu Haber, who founded the Matnat Chaim ("Gift of Life") organization of kidney donors in Israel, has died of coronavirus. He was 55 years old.

YNet has the story:
הרב שהציל חיים נפטר מקורונה (Google Tranlate: The rabbi who saved lives died of corona)

Here's a story in English from Vos Iz Neias? (Yiddish: "What's New?")
Rabbi Yeshayahu Haber, Who Founded “Gift Of Life” For Kidney Donations, Passes Away From Coronavirus

and this from the Jerusalem Post:
'Gift of Life' founder Rabbi Haber passes away at age 55 due to COVID-19

"Haber's funeral will take place at 2 a.m. in Jerusalem. The public is asked not to come to the funeral procession."
GIFT OF Life: Matnat Chaim donors, 2016-2017.


Here are all my posts on Matnat Chaim, which recently recorded its 800th kidney donation.

Tuesday, January 28, 2020

Patricia Kravey on non-directed organ donation

From my recent email, a nuanced yet inspiring story from non-directed donor Patricia Kravey.


"I’ve been meaning to write you for five years so it’s time I finally got around to it, but I’ll try to keep it short.
I’d been thinking about being an altruistic for many years without people being able to understand why. When my husband heard your interview on Freakonomics he finally got it and shared the podcast with me.
Your chapter on Kidney Chains has changed my life and the five people who received kidneys in the chain I was a part of. Without the power of knowledge from your book I would not have understood why my hospital was resistant to creating a national chain that went outside their hospital system. From your chapter I called the National Kidney Registry and UNOS to ask how they formed chains, how many people could receive kidneys in their chains and the barriers hospitals encounter in joining their programs. On the phone I was thrilled to speak to Ruthanne Leishman, she was in your book, she was famous!
After learning the cost for hospital to join NKR even though they have lengthy donor chains; I told my hospital, where I was also an employee, that I would only be donating through them if they participated in a chain through UNOS. Despite my request to wait the hospital ran their program and matched me internally. So I had this heavy weight of decision to give to the highly sensitized person my hospital matched me with or to pursue a donor chain. After sleepless nights I came up with what I thought was the perfect solution. I would agree to give to the recipient within the hospital and their mismatched donor would be the person officially enrolled in the UNOS program.
The surgery to my anonymous recipient went smoothly. I cried when the doctors told me he was doing well.
Months later I bumped into my transplant coordinator in the hallway at the hospital and she excitedly told me a news story was being released tonight. The mismatched donor of the person I had given to had completed her surgery and the kidney chain and continued on in the mad rush of 24 hours across the country. The news story was going to be about the hospital’s first national donor chain and the person who started it.
Since my donation wasn’t within the exciting 24 hours my hospital had decided I wasn’t part of the chain. I wasn’t included in the news story or even formally told about it. The story showed my recipient who I hadn’t decided if I was going to meet yet. My colleagues saw the story that night and could tell it was my story that didn’t include me.
Your book helped me understand why the hospital and the media would do that as well.
I did meet my recipient in person later. He was a lovely man. Charming, appreciative and so full of energy. He visited me at my office at the hospital several times and he sent a gift for my baby shower. I felt very lucky and grateful to have met him.
Four years after the transplant he died. Skin cancer got him. His wife told me the doctors had led him to believe that the kidney he’d received from me could be passed on. Of course it couldn’t be since it could contain cancer cells.
I have mixed feelings about being an altruist donor. It wasn’t perfect. It wasn’t the story or the fulfilling experience I had hoped it would be. But it was better and it benefited more people because of you. I hope people tell you everyday that your work has changed lives.
Thank you.
Best regards,
Patricia Kravey (Harvey)

(in rereading my interview in Swedish Medical Center's blog, I’m embarrassed that I didn’t cite you!)"