Regulation of transplant centers and OPO's

I'll be speaking this morning on regulation of transplantation at the 2020 Winter meetings of the American Society of Transplant Surgeons in Miami.

I'll be in a  Special Invited Presidential Session: Transplantation Metrics Roundtable     Moderators:Lloyd Ratner, MD, MPH Timothy Pruett, MD

Transplantation Metrics Roundtable
Time	End Time	Presentation	Speaker	Moderators
10:05 AM	10:20 AM	Welcome and Introduction	Lloyd Ratner, MD, MPH	Lloyd Ratner, MD, MPH Tim Pruett, MD
10:20 AM	10:35 AM	Introductory Presentation from Dr. Pruett	Tim Pruett, MD
10:35 AM	10:50 AM	Introductory Presentation from Dr. Roth	Al Roth, PhD
10:50 AM	12:00 PM	Transplantation Metrics Roundtable Discussion	All panelists (listed below)

Panel Participants

Paul Conway – Chair of Policy and Global Affairs and Immediate Past President of AAKP

Alexandra Glazier – CEO of New England Donor Services

Rick Hasz, BS, MFS, CPTC – Vice President of Clinical Services for the Gift of Life Donor Program

Maryl Johnson, MD – President of UNOS and Professor of Medicine, Heart Failure & Heart Transplantation at University of Wisconsin

Richard Knight, MBA – President of AAKP

Kevin Longino – CEO of the National Kidney Foundation (NKF)

Jean Moody-Williams, RN, MPP – Deputy Director of the Center for Clinical Standards and Quality at Centers for Medicare and Medicaid Services (CMS)

Ken Moritsugu, MD, MPH, FACPM – Rear Admiral, U.S. Public Health Service (Retired) and Acting Surgeon General of the United States in 2002 and from 2006–2007

Alvin Roth – Professor of Economics at Stanford University and awarded the 2012 Nobel Memorial Prize in Economics

The title of my talk (which Alex Chan and I prepared) is:
Performance Metrics and Regulation of Transplantation

Kidney donor athlete: Steve

Kidney donors have to be in excellent health, and the site Kidney Donor Athletes celebrates some exceptional donors, particularly as they return to their physically active lives after donating a kidney.

The recent entry Meet Kidney Donor Athlete, Steve!,  is inspiring on multiple levels. It is the story of the donor (and the people he met along the way) who started the chain at Virginia Mason hospital in Seattle, that I blogged about after hearing from the transplant nephologist Dr. Cyrus Cryst:

Monday, March 25, 2019

Followup on the latest Freakonomics kidney exchange chain

Here's how he describes his wife's reaction to his decision to become a non-directed donor:
"My wife said to me “This is the weirdest midlife crisis I have ever heard of.”  I told her, “You know, some guys buy Corvettes and have affairs.”  That quieted her down.  For a minute."

And here's a thought on where chains can go:
"I was elated to learn that the other donation would be to a Native Alaskan woman from Utqiagvik, Alaska, which is the northernmost town in the U.S.  Just think of how terrifying it must be to live in an Arctic village with a serious health problem.  Her odds of receiving a kidney were very small.  There is no way she could have gotten herself to Seattle in time to receive a deceased person’s kidney.  She does not live right around the corner.  And, having spent much of my working career sailing all over the Bering Sea and the Arctic Ocean, I have a deep emotional connection to Alaska.  It just felt right."
******

In separate correspondence, I learned that one of the hardships for Debbie, from Utqiagvik in Alaska, was that for some time after her transplant "it meant I couldn't eat raw whale muktak (outer skin and blubber of the whale ) which i love..."

Sharing good health: a nice turn of phrase about kidney exchange

This struck me as a nice turn of phrase:

On Paired Kidney Donation: ‘Good Health is Never Something I Thought I Could Share’
By REBECCA SMITH • JUL 25, 2019

"One of the things I've learned is being blessed with good health is never something I thought I could share. I mean, your good health is yours. There's… I guess there are ways to share it in the sense that you can lift up other people by being healthy, but I never thought it was something I can actually literally give away in a way.

The day I went to the hospital, I remember a doctor saying that living donors are the only people that walk into a hospital and don't need to be there. Who undergo surgery and absolutely don't need surgery that day. So, being able to give away a little bit of my good health, which was really a profound lesson for me.

I will say giving an organ, the benefits far, far far outweigh the risks. The surgery was incredibly uneventful for me, the recovery was really uneventful, and in fact, it made me a lot more mindful about my own health.

On the downside, I will say, as I've said before, the system is very complex, it's very difficult to navigate. For, particularly for someone who has a chronic disease, we're often left to self-navigate the emotional, financial and social barriers related to transplant, while struggling to try to maintain some quality of life.

And so, between the two of us, we were trying to climb this huge mountain of how to figure out how to get them a functioning kidney.

The unintended consequences that I never saw coming, that are have really been a blessing are, I learned the value of being a fierce advocate in the healthcare system and I will never stop being a fierce advocate for my family, for myself and for my loved ones.

I also found my voice when it comes to talking about health care, and I'm deeply respectful of healthcare systems and of healthcare providers, but I also know that without a loud and informed and passionate voice, often, nothing good can happen to you in this system. "

Dead pigs and live brain cells--with implications still to be understood

Dramatic scientific announcements get press coverage before they are well (or at all) understood, but that can still be exciting.  Here's some press coverage of an article that was published yesterday in Nature about restoring some cellular activity in the brains of pigs which had been slaughtered and decapitated.  It may eventually have implications for brain injuries, brain death and (hence) deceased organ donation.
(The Nature article and two commentaries published with it are also linked below.)

NY Times:
‘Partly Alive’: Scientists Revive Cells in Brains From Dead Pigs
In research that upends assumptions about brain death, researchers brought some cells back to life — or something like it.

"In a study that raises profound questions about the line between life and death, researchers have restored some cellular activity to brains removed from slaughtered pigs.

"The brains did not regain anything resembling consciousness: There were no signs indicating coordinated electrical signaling, necessary for higher functions like awareness and intelligence.

"But in an experimental treatment, blood vessels in the pigs’ brains began functioning, flowing with a blood substitute, and certain brain cells regained metabolic activity, even responding to drugs. When the researchers tested slices of treated brain tissue, they discovered electrical activity in some neurons."
***********

Washington Post:
Scientists restore some brain cell functions in pigs four hours after death
Ethicists advise caution with research that blurs the line between life and death.

"The researchers are mindful that this is controversial territory with great potential to stoke outrage or, simply, the heebie-jeebies. Such a head-snapping experiment inevitably generates nightmarish scenarios involving live brains in vats, brain transplants, the Zombie Apocalypse, and other mad-scientist story lines (brilliantly crafted, somehow, by neurons firing away inside the skulls of conventionally living human beings).
"The findings also lead to ethical quandaries, some of which are outlined in two commentaries simultaneously published by Nature. The ethicists say this research can blur the line between life and death, and could complicate the protocols for organ donation, which rely on a clear determination of when a person is dead and beyond resuscitation."
*************

Guardian:
Researchers 'reboot' pig brains hours after animals died
Scientists say ability to revive some brain functions will not change definition of death



************
And here's the article in Nature:
Published: 17 April 2019

Restoration of brain circulation and cellular functions hours post-mortem
Zvonimir Vrselja, Stefano G. Daniele, John Silbereis, Francesca Talpo, Yury M. Morozov, André M. M. Sousa, Brian S. Tanaka, Mario Skarica, Mihovil Pletikos, Navjot Kaur, Zhen W. Zhuang, Zhao Liu, Rafeed Alkawadri, Albert J. Sinusas, Stephen R. Latham, Stephen G. Waxman & Nenad Sestan
Naturevolume 568, pages336–343 (2019) | Download Citation

Abstract
The brains of humans and other mammals are highly vulnerable to interruptions in blood flow and decreases in oxygen levels. Here we describe the restoration and maintenance of microcirculation and molecular and cellular functions of the intact pig brain under ex vivo normothermic conditions up to four hours post-mortem. We have developed an extracorporeal pulsatile-perfusion system and a haemoglobin-based, acellular, non-coagulative, echogenic, and cytoprotective perfusate that promotes recovery from anoxia, reduces reperfusion injury, prevents oedema, and metabolically supports the energy requirements of the brain. With this system, we observed preservation of cytoarchitecture; attenuation of cell death; and restoration of vascular dilatory and glial inflammatory responses, spontaneous synaptic activity, and active cerebral metabolism in the absence of global electrocorticographic activity. These findings demonstrate that under appropriate conditions the isolated, intact large mammalian brain possesses an underappreciated capacity for restoration of microcirculation and molecular and cellular activity after a prolonged post-mortem interval.
*********
Here are two commentaries published in the same issue of Nature:
COMMENT  17 APRIL 2019
Part-revived pig brains raise slew of ethical quandaries
Researchers need guidance on animal use and the many issues opened up by a new study on whole-brain restoration, argue Nita A. Farahany, Henry T. Greely and Charles M. Giattino.
^^^^^^^^^

COMMENT  17 APRIL 2019
Pig experiment challenges assumptions around brain damage in people
The restoration of some structures and cellular functions in pig brains hours after death could intensify debates about when human organs should be removed for transplantation, warn Stuart Youngner and Insoo Hyun.

Podcast on non-directed kidney donation as an act of effective altruism

Here's a very personal discussion  about becoming a non-directed donor.

The Neoliberal Podcast

Donating a Kidney with Dylan Matthews

"Jeremiah sits down with Dylan Matthews of Vox.com to discuss his decision to donate a kidney to a stranger, and Jeremiah's plans to do the same.  While our previous episode with Nobel prize winner Alvin Roth explored the economics of kidney markets and the details of kidney policy, this episode dives more deeply into the medical and personal side of deciding to donate a kidney."
***********

Dylan Matthews has his own podcast, called Future Perfect.

Followup on the latest Freakonomics kidney exchange chain

Earlier this month I blogged about a kidney exchange chain at Virginia Mason Hospital, in Seattle, initiated by a non-directed donor who had heard an interview about kidney exchange on Freakonomics.  Subsequently, my colleague Elena Cryst, whose dad is a transplant nephrologist at that hospital, sent her the email below about a short talk he'd prepared, which they have given me permission to reproduce with minor edits. (They also note that "the participants OK’d sharing this so no HIPA violations.")

Dr. Cryst writes:

"I’m a transplant nephrologist, and  I’m  sharing this story on the insistence of these four patients who want to get their story out and encourage others to participate in organ donation and increase the options for kidney transplants in our country”

This is a photo of 4 people – I hope you can see them as you read this.

Three out of four of these folks in the picture just so happened to have appointments in my Monday AM clinic.  I’ve been taking care of kidney transplant patients for thirty years, but by the end of clinic, I was astounded by seeing how much this meant for each one of them and the different reasons why.  As this morning went on I heard this story from three of the four points of view.  It very much took me by surprise how much had changed for all four.…  It was just another day in the office, but this story is striking and they all wanted to share it with everyone in hopes more people can receive transplants.

THE PHOTO: 

THE STORIES:  First with hat on backwards is DC my patient.  A naturally shy and private person.   Happiest I’ve seen him in three years but has had many disappointments.   It has been an emotional roller coaster, as three years ago he thought he was passing a kidney stone- only to learn he had an advanced kidney disorder and soon would either need to get a transplant  or start on dialysis.  There had been lots of struggles to get to the point of transplant…. one by one, donors came forward but were disqualified due to minor health issues.  Finally one did  get through testing and qualify to donate, only to find out she was not a match.  He was devastated again.  After working with our program, we were poised for a paired donor exchange but with time running out…we needed a non-directed donor to step forward.  If someone could donate for DC, his donor would give a kidney for the next person on our waiting list and he would not have to start the process of dialysis. 

Next to DC’s left is Steve, healthy tugboat pilot who commutes to his home inland and on the way listens to lots of podcasts.  Freakonomics Radio had one about Al Roth, a Nobel prize winning economist at Stanford who researches how to create markets for things that don’t have a price.  He was the economist who worked to redesign the resident matching program to accommodate couples in the 1990’s and was fascinated by the challenge of how to allocate kidneys from live donors.  This is another problem of how to make a market for something that could not be exchanged for cash.  He and colleagues designed the system and did the math.  And won the Nobel prize!  Steve caught on to a few facts in the story – like the huge number of potential living donors in this country, and the benefit that could be afforded to those waiting for a kidney from a deceased donor.  The fact that the number of such paired donor exchange transplants has grown from only 2  in 2000 to 1000 in 2018, and said sign me up.  His generosity and courage started this chain of events.  Al Roth’s work is changing the way we are doing kidney transplants at my hospital and bringing in more and more living donors together with recipients they don’t know. The process was hugely important to Steve and it was icing on the cake that he was able to meet DC after it was done.  They all mutually agreed to make the process open rather than confidential which was their personal choice.

Next is Debbie from Ukqiagvik Alaska (formally Barrow)  – the literal ‘end of the earth’ the northern most point in the USA above the arctic circle in Alaska.   Debbie is an Alaska native who toughed it out with barely enough renal function for many  years but time was running out for her as well.  She was at the very top of the waiting list and she was waiting for a deceased donor kidney at our far away transplant center. The logistics of urgent travel to a faraway city fast enough to get a kidney transplant from a deceased donor -- while the clock was ticking -- made it much more better for her to have a living donor transplant that could be scheduled.  As you can tell Debbie has been delighted with her new kidney.  She is a long way from home for a few months, but enjoying the challenges of being in the city, even trying foods not part of her diet - like cucumbers (“not my favorite” she says) - not often available above the arctic circle!  She is here with family for a few months recovering and adapting to having normal kidney function again.

Next is Wendy – Journalist, community organizer and friend of DC.  She did gently insist that he let her get tested to donate.  He was apprehensive and certainly did not want to ask her.  But, as usual, Wendy prevailed.   In exchange her kidney went to Debbie who now feels better than she has in years.  Wendy is being ‘adopted’ by the women in Ukqiagvik and in clinic that morning, she was wearing the traditional hoodie blouse with big pockets that Debbie’s sisters back home had specially made for Wendy.  She is thinking about how to make the trip up north to see her new family of friends.  It was Wendy who also gently admonished me for not doing a better job of telling our story to others.  She strongly felt that we need to point out that her life and Steve’s are forever changed for the better - -  as well as the obvious benefit for DC and Debby. 

Although this is the kind of work we do every day, we would like to do many more living donor transplants for people and take more people off the waiting lists and out of the dialysis units.  There are a lot of moving parts and a lot of people who contribute, but we can scale it up.  The more scheduled procedures we do, opposed to deceased donor surgeries which are by necessity emergency surgeries, the greater our impact  can be. Each living kidney transplant also frees the deceased donor kidney to go to someone else - in effect doubling the benefit.  Thanks to Al Roth, there is now a new market for getting our willing donors together with recipients they do not know.  We always respect privacy and our default is to keep this process of ‘entering the market’ safe and anonymous.  But, as in this case, the participants can decide to share their experience, meet each other and . . . as Wendy said, “get the word out.”   In fact this photo captured the moment after surgery where this group organized a first meeting on their own and went off for lunch.  As a kidney transplant physician, I know we have the systems in place to grow this work.  Facilitating living kidney donation benefits not only more recipients, but it positively  changes lives of these donors.  It really positively affects lives of everyone involved. . .even the doctors like me…and I bet even the economists! 

Cyrus Cryst MD FASN

Another kidney donor from the Freakonomics interview

Yesterday I got this cheerful email from Harry Huggins at Freakonomics, about another nondirected donor motivated to start a kidney exchange chain, after learning about them on Freakonomics:

"Hello Professor Roth,

I'm a producer at Freakonomics Radio. I just wanted to let you know that we've published a post on our blog about another listener inspired by your episode to donate a kidney. You can find it (the blog post, not the kidney) here: 

Another Kidney-Donation Story to Make You Smile

Hope all is well,

Harry Huggins
Managing Producer
Freakonomics Radio"

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

I now know of several donors who heard the original 2015 Freakonomics story on kidney exchane (Make Me a Match (Ep. 209)). The first was Ned Brooks (who writes about it at the link), and whose web page/organization Donor to Donor speaks about others.

And here are all my posts that mention Freakonomics, many of them (but not all) related to kidney exchange.

Kidney matching podcast: Jeremiah Johnson interviews me and Josh Morrison

On the Neoliberal Podcast (49 minutes):
Kidney Matching featuring Dr Alvin Roth & Josh Morrison

Josh Morrison, who donated one of his kidneys as a non-directed donor, is a founder of Waitlist Zero.
*******

The audio connection seemed to change my voice a bit: here's an unusual comment, forwarded to me by a twitter-literate colleague:

Replying to @ne0liberal @JoshMorrison @waitlistzero

Dr Roth has the velvetiest voice I’ve ever heard

(if you find voices entertaining, you can compare it to the audio in yesterday's post, where I thought I sounded more like myself.)

Kidney exchange chains and altruistic kidney donation on PBS newshour

PBS economics correspondent Paul Solman interviews non-directed kidney donors, and kidney exchange patients, and me, in yesterday's PBS newshour.

Here's a link to video of the 10 minute segment on kidneys, including a transcript.
How an economist’s idea to create kidney transplant chains has saved lives

and here's the video itself:

The show talks about how a single altruistic donor can initiate a long chain of kidney transplants that helps many people.

The kidney exchange organization that started non-simultaneous non-directed donor chains is the Alliance for Paired Donation, run by Mike Rees, and I think that they still organize the longest chains, i.e. the ones with the highest average number of transplants.  

The very first long chain was reported in this article in the New England Journal of Medicine:

Rees, Michael A., Jonathan E. Kopke, Ronald P. Pelletier, Dorry L. Segev, Matthew E. Rutter, Alfredo J. Fabrega, Jeffrey Rogers, Oleh G. Pankewycz, Janet Hiller, Alvin E. Roth, Tuomas Sandholm, Utku Ünver, and Robert A. Montgomery, “A Non-Simultaneous Extended Altruistic Donor Chain,” New England Journal of Medicine, 360;11, March 12, 2009

Here's the full hour-long newshour: kidneys are from about minute 34:46 to minute 44:38 on the video below.

Kidney transport: a Tesla and a flat tire

Transporting kidneys can be surprisingly informal.  Here's an account of a Tesla, a flat tire, and hitching a ride.

Good Samaritan drives stranded surgeon, donor kidney to Pa. hospital

"Dr. Martin Wijkstrom had two jobs to perform Wednesday evening: Drive a donor kidney from Pittsburgh to Erie, Pa., then implant the organ in a patient at UPMC Hamot.
...
“I had already picked up the kidney at a Pittsburgh hospital and had just charged my Tesla in Cranberry Township,” said Wijkstrom, a UPMC transplant surgeon. “I was driving to get back on (Interstate 79) to go to Erie when I struck a pothole.”

"The pothole caused one of Wijkstrom’s tires to go flat. He was stuck in the Cranberry Mall parking lot with a donor kidney, 108 miles from the hospital where a patient waited to receive it.

"His Tesla didn’t carry a spare tire. Though the kidney was secured in a refrigerated container in Wijkstrom’s trunk, the surgeon had about 12 hours to implant the organ for the best chances of success.

“It wasn’t an emergency situation but we needed to put the kidney into the patient as soon as possible,” said Wijkstrom, who said he had transported kidneys in his car three or four previous times.
...
"Brad Dostlik was driving his Nissan Sentra near the mall, listening to his portable police scanner.
He heard a dispatcher send police to the surgeon’s car and notify them about the kidney. Dostlik, who was headed to the nearby Field & Stream store, decided to see if he could help.
...
“He asked if I could take him to Erie,” Dostlik said. “I had a full tank of gas, so why not?”
...
“I learned a lot of stuff during the trip,” Dostlik said. “I don’t think I could do what he does.”
...
"The two men shook hands and the surgeon walked into the hospital with the donor organ, just 40 minutes later than expected.

“The surgery was uneventful,” Wijkstrom said. “The patient is doing well, his kidney is making some urine already.”

Organ donation in Germany

Spiegel.de has the story:
Nach langem Abwärtstrend, Zahl der Organspender deutlich gestiegen
(GT: After a long downward trend, the number of organ donors has increased significantly)

"Last year, 955 people left organs for other critically ill patients after their death, as the German Foundation for Organ Transplantation (DSO) announced. That was an increase of nearly 20 percent compared to 2017 with 797 donors and the first major increase since 2010.
...
"a discussion on new organ donation rules has started in parliament across parliamentary boundaries. So far, withdrawals are only allowed with expressly agreed consent, but many postpone the occupation with this topic again and again.

"Spahn is therefore campaigning for a "double contradiction solution" ["doppelte Widerspruchslösung"]. Accordingly, everyone is automatically considered a donor. One should be able to say no to this, otherwise - as a double barrier - relatives would have to be asked. In an open debate in the Bundestag at the end of November broad reservations against such a new regulation became clear.

"Instead, a group led by Greens leader Annalena Baerbock and left-leaning boss Katja Kipping suggests a mandatory recurring query, such as collecting new passports or identity cards - with the option of not yet deciding."
**********

HT: Rosemarie Nagel

Two bills aimed at increasing the number of transplants

The Niskanen Center has a post on two proposed pieces of legislation (together with some thoughts on why incremental policy oriented work is important):

TWO NEW BILLS WILL HELP WITH THE KIDNEY SHORTAGE. BUT PAYING DONORS COULD HELP EVEN MORE.
BY SAMUEL HAMMOND

Here's the  first paragraph of their article, and the  last.


"Last week, the Organ Donation Clarification Act was released by Rep. Matt Cartwright (D-PA) with 14 cosponsors. The bill would clarify the National Organ Transplant Act’s (NOTA) definition of “valuable consideration,” making it clear that donors can be compensated for medical expenses and lost wages. It would also permit the U.S. government to run pilot programs to test the viability of noncash rewards to incentivize donors. And now this week, Rep. Tom Rice (R-SC) has announced a set of amendments to NOTA that seek to orient the Health Resources and Services Administration toward increasing organ procurement, rather than simply distributing an inadequate supply."

...
"At the same time, the Niskanen Center’s overall mission eschews ideal theories in favor of pragmatic policy change. Thus, as much as I’d love to see someone like Al Roth appointed as the organ transplant czar, with a mandate to design an optimal market in organs, politics is a long game of persuasion and compromise. That’s why the two new bills from Reps. Cartwright and Rice remain immensely important, even if they don’t nearly go far enough."

One kidney donor's journey

I recently heard the following story, by email from a recent kidney donor, who has given me permission to share it. It's lightly edited to preserve her privacy and mine, but I can't resist noting that her first name is Hope.

"Dear Professor Roth,

"Seven weeks ago today, I donated a kidney to a stranger in Minnesota.  Mayo Clinic sent me his email address this afternoon, just in case I want to contact him.  I'm not sure yet if I want to initiate communication but I certainly can't stop thinking about it.  It made me think about the Freakonomics episode I heard three years ago that started everything.  You know the one...

"When I heard the episode, I knew right away I wanted to become a living kidney donor.  I was 49 at the time. I never had children and my life felt incomplete.  Moreover, I lost my mother to cancer after a long battle, when I was just 14 years old.  I daydreamed about helping a child who had a sick parent so she doesn't have to go through what I went through. 

"My wife's cousin needed a kidney shortly after the episode aired.  I asked her if it was ok if I stepped up.  I played her the Freakonomics episode and she approved.  I reached out to her cousin Rick.  It turns out a few people volunteered and he got a direct match.  I felt defeated, which sounds selfish after such good news.  Then I heard a follow up episode that united a donor with his recipient.  Stephen Dubner was crying... I was crying... I called Mayo Clinic the next morning and signed up for testing.

"The rest is a long story and I know you are a busy man so I'll skip most of it.  I ended up being part of a pair, instead of an altruistic donor.  There was a man who worked with my wife that needed a kidney.  He once saved her life with the Heimlich maneuver so it was pretty poetic that I could save his.  He received his kidney from a bridge donor and I gave mine to someone on the diseased donor list.  So I got to save two lives!  I'm doing great.  I went back to work a couple of weeks ago.  I have no regrets and I hope I can inspire others to do something selfless and extraordinary in their lifetime. 

"I hope others have written to you.  I'm sure you see the statistics and know the impact of what you created with paired kidney donation.  I just wanted to make sure you hear some personal stories.  Life changing stories..."

A subsequent email exchange clarified some details:

"Hi Al!  I did all of my testing in May of 2016 to be a non-directed donor. I tested positive for Valley Fever and had to wait 90 days to be retested. The 2nd test was negative and I was approved but I was getting married in October so we put a hold on the donation. Mark came into the picture after that. He didn’t know about paired donation. We got him to switch to Mayo and we became a pair. He had lots of complications so I had to wait a long time. When he was finally approved, so much time had passed that I had to do most of the testing all over again. It took awhile to find me a match because I’m AB+. 

So a false positive Valley Fever test got Mark a kidney. 

I met Mark the day of his surgery. My wife and I were the first faces he saw. He was there the day of mine. He brought me flowers and a card from his kids. 

My team at Mayo Clinic were there for me the whole time. There was never any pressure and changing from non-directed to paired was seamless. They never discussed Mark. He had his own team. I was allowed to chicken out at any time. But I’ve never been so sure of anything in my life."
***********

And here are my posts linking to the Freakonomics shows that gave people so much of Hope.

Thursday, June 18, 2015

Freakonomics podcast on Who Gets What and Why

Make Me a Match: A New Freakonomics Radio Episode

Friday, February 26, 2016

A Freakonomics listener was inspired to become a non-directed kidney donor by the podcast on kidney exchange

Ask Not What Your Podcast Can Do for You

and this one (from huffingtonpost.com):

Saturday, May 6, 2017

A non-directed kidney donor speaks about his experience (which started with a Freakonomics podcast)

Ned Brooks: Donating His Kidney was Life-Changing. For Him.

Gratitude for an organ donation

Only a curmudgeon (and I know some) would think of this as (illegal) donor compensation.

Here's a story from the Greeley, Colorado Tribune

Labor of Love: Husband of former city councilwoman works to restore old car for kidney donor

A liver for a kidney?

One consequence of the growth of kidney exchange is that there is more discussion of novel modes of exchange. Here's an article forthcoming in the American Journal of Transplantation that cautiously discusses the ethical issues that would be involved in a kidney-liver exchange.  I found the most interesting of the issues discussed to be those surrounding the excuse that medical teams give to prospective donors who don't really want to donate: they say e.g. that the kidney isn't suitable, or that the donor's kidney function isn't sufficient to allow him/her to donate. So the article discusses how this might pressure a reluctant donor if the question "but how about his/her liver"? could be asked...

The main case being discussed of course is one in which two lives could be saved by an exchange of donors, as in kidney exchange (or liver exchange, as has been employed a bit in Asia...).

(Incidentally, the article is written in the future hypothetical, but I wouldn't be shocked to hear that somewhere in the U.S. one such exchange has already taken place.)

New in the AJT:

A Liver for a kidney: Ethics of trans-organ paired exchange

Authors

• 
  

  
  

  
  

• 
  

  
  

• 
  

• 
  

• 
  

• Accepted manuscript online: 14 February 2018 
• DOI: 10.1111/ajt.14690
• American Journal of Transplantation (forthcoming)
• Abstract
• Living donation provides important access to organ transplantation, which is the optimal therapy for patients with end-stage liver or kidney failure. Paired exchanges have facilitated thousands of kidney transplants and enable transplantation when the donor and recipient are incompatible. However, frequently willing and otherwise healthy donors have contraindications to donation of the organ that their recipient needs. Trans-organ paired exchanges would enable a donor associated with a kidney recipient to donate a lobe of liver and a donor associated with a liver recipient to donate a kidney. This paper explores some of the ethical concerns that trans-organ exchange might encounter including unbalanced donor risks, the validity of informed consent, and effects on deceased organ donation.