Kidney exchange comes to Hungary

Péter Biró  writes with good news about kidney exchange in Hungary.

 Here's the announcement from the  University of Pécs, of the first kidney exchange performed in Hungary, following the first legislation passed to legalize kidney exchange in 2014. (And more details follow from a second announcement below.)

The first cross-donation kidney transplant was performed in Hungary at the University of Pécs Clinical Center  2026.01.29

"The first cross-donation kidney transplant performed in Hungary a few days ago can be considered a new milestone in the history of organ transplantation in Hungary. Within the framework of the living donor kidney exchange program, two women received new kidneys at the Department of Surgery of the University of Pécs Clinical Center (PTE KK), which gives them the opportunity for a better quality of life. It is particularly interesting that in both cases the organ donor was a male member of the other couple.

...

"In his speech, Dr. Péter Szakály, Head of Department of the Department of Surgery of the University of Pécs, emphasized that: The establishment of a national pool was of fundamental importance in this program, and this program will be able to operate successfully in the future as well if there are as many such couples as possible. He also added that compared to traditional kidney transplantation, living donor transplantation is always a much greater challenge (...) Transplantation with a living donor comes with increased responsibility, as it involves a healthy donor. In this case, two surgeries were performed at the same time: Ádám Varga, assistant professor, and I simultaneously removed and replaced the organs between the two pairs from the adjacent operating room. 

"Since 2014, the law allows this type of transplant, but no specific surgeries have been performed so far. Recognizing this shortcoming, at the initiative of the National Hospital Administration, the four kidney transplant centers in Hungary and the Regional Kidney Transplant Committees operating there, in cooperation with the National Blood Transfusion Service, have developed a nationally uniform program in accordance with the legislation in force, which ensures equal opportunities for all patients who voluntarily enter the program. This became the living donor kidney transplant exchange program, which was launched in Hungary on June 21, 2024. The search for optimally compatible pairings between the pairs applying for the program is carried out with the help of a software developed for this purpose." 

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And here is the emailed announcement forwarded by Peter Biro, who has been a champion of kidney exchange in Europe for many years now:

Dear EURO-KEP Colleagues,

 

We are pleased to inform you that we have reached a significant milestone within the Hungarian Kidney Paired Kidney Exchange Program (HKEP), in line with the objectives of the EURO-KEP initiative.

 

On January 20, 2026, the first two kidney transplants were successfully performed in Hungary within the national living donor kidney exchange program. The surgeries took place at the University of Pécs Clinical Centre, marking the first realization of kidney cross-over donation in the country.

We believe that this milestone, supported by a well-structured professional and patient information campaign lasting more than a year and a half, will contribute to increasing the number of living donor kidney transplants and encourage more patients and voluntary donors to join kidney exchange programs. This, in turn, will support further kidney exchanges and improve equal access to transplantation.

 

Chronology and key developments of the Hungarian KEP

• June 2024 – With the support and authorization of the National Directorate General for Hospitals (OKFŐ), a nationally unified kidney paired exchange program was launched, coordinated by the National Blood Transfusion Service, with the participation of all four Hungarian kidney transplant centers and regional waiting list committees.
• Since the launch – The matching algorithm has been run every three months; to date, six matching runs have been completed, involving 57 donors and 44 recipients. The seventh run is scheduled for tomorrow.
• July 2025 – A key legislative amendment entered into force, allowing:
• simultaneous transplants among more than two donor–recipient pairs in a closed chain,
• transplant surgeries to be performed in different centers, enabling patients to remain at their original listing centers and
• not only incompatible pairs can join the program, but compatible pairs in the hope of better matching.
• Following the legal amendment, an updated and detailed printed patient information package was distributed nationwide, with the involvement of all dialysis units and transplant centers.
• During the optimization process, a clinically acceptable match was identified between two married couples. In both cases, the male partner donated a kidney to the female recipient of the other couple. The transplant surgeries were performed on 20 January 2026 at the Surgical Clinic of the University of Pécs Clinical Centre. In both cases, graft function started immediately. The recipients and donors are in good condition and both patients were discharged home on Friday.

We consider this achievement a significant milestone in Hungarian transplantation and a meaningful contribution to the shared European objectives of the EURO-KEP project. We remain committed to continuing this work in the service of saving lives.

 

Best regards,

 

Dr. Sándor Mihály, Ph.D  
Director of transplantation

Honorary College Associate Professor at Semmelweis University

General Secretary of the Hungarian Transplant Society

EDTCO Past-Chair 2023-2025

 

 

Organ Coordination Office

Central Waiting List Office

National Organ and Tissue Donation Opting-out Registry

Hungarian Stem Cell Donor Registry

 

Spam invitation to be featured in a book club

 As the author of a forthcoming book (Moral Economics) I now get book-related emails from publicists, podcasters and others.  But I suspect I was the first human to see the email below, inviting me to be featured in a book club, which began with this sentence:

"I’m writing because "The Nash solution and the utility of bargaining" has stayed with me, thoughtful, layered, and resonant in a way that invites real conversation. It felt like the kind of book our readers would want to spend time with."

 It purported to come from the organizer of an apparently real book club (Bellatrist), but alas the return email didn't pass the smell test (despite coming from such a perceptive reader of the paper below...)

 Roth, Alvin E. "The Nash solution and the utility of bargaining." Econometrica (1978)

 Abstract: "It has recently been shown that the utility of playing a game with side payments depends on a parameter called strategic risk posture. The Shapley value is the risk neutral utility function for games with side payments. In this paper, utility functions are derived for bargaining games without side payments, and it is shown that these functions are also determined by the strategic risk posture. The Nash solution is the risk neutral utility function for bargaining games without side payments."

 

Thoughtful, layered and resonant.   

Kidney donation, in today's NYT

 Here's an article and an argument from a nondirected kidney donor, in today's NYT

 Want to Make a Difference? Donate Your Kidney.  by German Lopez, Feb. 2, 2026, 

"Nearly 50,000 people in the United States die each year because there are not enough kidneys for transplant, which adds up to more than double the number of annual murder victims. Hundreds of thousands more are on dialysis, a lifesaving but time-sucking and physically draining treatment. Humans need only one kidney to live, but we have two. Giving away my kidney, to a 23-year-old woman I didn’t know, has been the most fulfilling experience of my life.

...

"The chain is a wonderful, and fairly recent, innovation that has allowed many more people to get lifesaving transplants. Imagine three people — Patients A, B and C — need kidneys. B’s and C’s spouses are willing to donate, but Spouse B is a match for Patient A and Spouse C is a match for Patient B. They all agree to pull the trigger if a donor can be found for the remaining patient, C. An undirected donor can come in at that point to complete the chain of donations. The largest chain on record led to 126 transplants.

...

"I also learned about some of the health care system’s absurdities. As a gay man, I could donate my kidney but not my blood. The government prohibited blood donations from sexually active gay men until 2023, thanks to outdated fears about H.I.V. My kidney was fine, although the doctors had to inform the receiver that it was “higher risk.” Thankfully, the threat assessment did not deter the recipient from accepting my gay kidney.

...

My donation felt like a rejection of the day’s politics — and not just because it required overcoming some light homophobia. It felt like an act of defiance; I was plugging a small hole in a porous health care system while our leaders’ proposed cuts to Obamacare and Medicaid attempted to open a chasm."   

Tobacco banned in Indian state of Odisha

 Here's the story from the Times of India, Govt notifies ban on all chewable tobacco, nicotine products | Bhubaneswar News - The Times of India.  It remains to be seen how enforceable a statewide ban will be. (Local bans on something as addictive as nicotine are likely to face black markets sourced from neighboring jurisdictions without a ban.)

 

  

 

Tim Harford on British queues (and how queues get long)

 Here's a column in the FT on congestion and growing queue length, which (also) shows why Tim Harford is one of my favorite economics journalists.

How British Queues Got Out of Hand 

[Why are ambulances increasingly delayed?] "The obvious explanation is that there are not enough ambulances, but the deeper problem is that ambulances themselves are being delayed in discharging patients into A&E units, which are themselves often overwhelmed: in the first quarter of 2014, 134 patients waited more than 12 hours in A&E before being admitted; 10 years later the figure was 141,693. The long delays in A&E are in part the result of the hospital beds all being full and that, in turn, is in part because hospitals sometimes struggle to discharge vulnerable patients into an overstretched social care system. All of these problems are a kind of queue and they all interact in a surprising way: you can die waiting for an ambulance because there aren’t enough nursing homes in your area.

...

"when bottlenecks feed into bottlenecks, some strategic thinking is required to fix the system. There is often more than one bottleneck in a congested system and opening that bottleneck will sometimes mean the same queue builds up somewhere else."

Alex Chan on market design and organ transplants (and how to begin a video)

Alex Chan, at HBS:) 

https://youtu.be/8n6A9wO1yt0?si=VsaT0AVNgYc7VdnB

Redesigning transplant and OPO center incentives (Chan and Roth in JAMA; Bae, Sweat, Melcher and Ashlagi in JAMA Surgery)

 

Chan A, Roth AE. Reimagining Transplant Center Incentives Beyond the CMS IOTA Model. JAMA. Published online January 26, 2026. doi:10.1001/jama.2025.26194 

 "On July 1, 2025, the Centers for Medicare & Medicaid Services (CMS) launched the Increasing Organ Transplant Access (IOTA) model, a national experiment in revising how transplant centers are evaluated and paid.

"For decades, transplant centers were primarily judged by 1-year graft and patient survival for patients who underwent a transplant. That standard, designed to safeguard quality, sometimes constrained access to transplants by rewarding risk avoidance rather than expansion. This contributed to persistent kidney shortages, alongside continued organ nonutilization.1

"The IOTA model marks a deliberate rebalancing. CMS is tying payment not primarily to short-term survival, but to 3 domains: achievement (60 points for transplant volume), efficiency (20 points for kidney offer acceptance), and quality (20 points for graft survival).

...

"A kidney transplant begins with an organ procurement organization (OPO). Yet OPOs remain outside the IOTA payment framework, perpetuating fragmentation between procurement and transplant.

"Recent experience with OPO performance metrics illustrates how narrow incentives can distort behavior. After CMS introduced tier-based OPO evaluations in 2021, lower-performing OPOs increased organ recovery, which also sharply increased discards, reliance on higher-risk organs, and out-of-sequence kidney placements,3 raising concerns about fairness to waitlisted patients.4 

...

"Emerging economic and experimental research suggests that joint accountability—rewarding procurement and transplant entities together for improving population health—can both shift recovery, discard, and transplant numbers and produce improved gains in patient health (Table).1 Without such system-level metrics spanning OPOs and transplant centers, IOTA will operate within a fragmented ecosystem where incentives push procurement and transplant in different, sometimes counterproductive, directions."

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See also

Bae H, Sweat KR, Melcher ML, Ashlagi I. Organ Procurement Following the Centers for Medicare and Medicaid Services Performance Evaluations. JAMA Surg. 2026;161(1):97–100. doi:10.1001/jamasurg.2025.5074