Sunday, June 6, 2021

Global kidney exchange with Denmark, in the U.S.

A Danish citizen with a willing but incompatible living donor, received a kidney exchange transplant in the U.S., through the Alliance for Paired Kidney Donation (APKD).

Denmark is a wealthy country that has good health care for its citizens. ScandiaTransplant has recently started kidney exchange.  But there wasn't a match there for this incompatible pair. Fortunately for them they encountered Susan and Mike Rees, who were in Copenhagen for a transplant conference.

But Danish health insurance couldn't find a will and a way to pay for the transplant in the U.S., so there were still financial barriers that had to be overcome. About two thirds of the needed funds were raised from private donations in Denmark, and about a third was covered by the AKPD.

ABC news first reported the story:
Chance meeting at bus stop in Denmark saves many lives 

"Natacha Kragesteen, 28, was born with a genetic defect that eventually led to her need for a life-saving kidney transplant. She lives in Denmark with her two young daughters and her boyfriend Louis Plesner.

"Louis wanted to donate a kidney to Natacha, but he was not a match. That left her on the kidney transplant waiting list for the last few years and undergoing kidney dialysis three times a week for four hours a day.
"The couple connected with Susan, who is a registered nurse, and Mike, who is a kidney transplant surgeon, and came to the conclusion that they would be helped in Toledo in the paired kidney exchange.
"The life-saving chain wouldn't just help the young couple. Louis's kidney would be flown down to Wake Forest University in North Carolina to help someone there, and the donor from Wake Forest donated a kidney to someone at Duke University. The Duke donor's kidney came to Toledo to save Natacha's life.

"In addition to this life-saving chain, the Minister of Health from Denmark is now considering opening that country to the paired kidney exchange program so that other people waiting for kidney transplants have a greater chance of getting one.

"So a chance meeting at a bus stop has the potential to save thousands of lives."
And here's an article from the Danish press (and Google Translate):

"After almost three years in treatment, the miracle happened. Louis was on a trip to Copenhagen and was waiting for a bus when he fell into conversation with two Americans at the stop.

"It turned out that they were researchers from Johns Hopkins Hospital in the USA, and that they had just been to a kidney conference in the Danish capital. 

"Louis told them about his girlfriend's situation, and they immediately offered their help. The two researchers knew the renowned kidney surgeon Michael Rees, who is behind a successful kidney exchange program in the United States.
" It was completely surreal when he showed up at the hospital. He explained to us about his kidney exchange program, where a kidney patient and a willing donor who unfortunately do not fit together are matched with other couples in the same situation. That way Louis could donate his kidney to a foreign patient who would then have his own donor ready who could donate a kidney to me. Several pairs could also be included in such a kidney exchange chain so that all kidney patients would get a kidney that fit them perfectly.

"A similar kidney exchange program exists in Scandinavia, but it would not have been possible for Natacha to find a kidney through this system due to the relatively small pool of donor pairs and Natacha's many antibodies.

" So I decided to give the American program a try, and Michael Rees took blood samples from both me and Louis home to the United States and ran them through his system. A few hours later, he had found six potential donors for me. I felt it was almost too good to be true.

"Maybe it was too. The operation cost 800,000 kroner, and like most others, Natacha and her family were nowhere near being able to pay the amount out of their own pocket. When they applied for financial help from the Danish state, they were rejected.
"Natacha refused to give up, however, and with the help of the businessman Claus Walther Jensen, who himself has kidney disease in the family and therefore has also had contact with Michael Rees, she started a fundraising campaign, where she via Facebook posts, newspaper articles and the website explained his situation and appealed to the support of the people. 
"On February 2, Natacha and Louis left for the United States to undergo their kidney surgery, which was to take place 11 days later at Toledo University in Ohio and performed by Michael Rees. Meanwhile, their two daughters were cared for by their grandparents back home in Denmark.
"Louis' operation did not go exactly as planned. During the operation, a vein ruptured and he was about to bleed on the operating table.

"The doctors therefore had to open him up completely to stop the bleeding, so he ended up getting a giant scar on his stomach instead of the expected three small scars where the kidney was taken out. 
"Nor did Natacha's operation go exactly as hoped. Shortly after the transplant, it turned out that the new kidney was not getting enough blood, so the doctors had to take it out again and try to angle it differently. It helped with the blood flow, but when Natacha subsequently started bleeding inside, she had to have surgery for the third time in  a few days.
"Today, Natacha is feeling better than she has been for many years. She takes immunosuppressive medication so that her body does not attack the new kidney, and is monitored regularly by the Danish healthcare system. But the time of countless hospitalizations and dialysis treatments is over.
"Natacha hopes that her story can raise awareness of the benefits of a kidney exchange program, and that in the future it will be easier for Danish kidney patients to have surgery abroad."
A Danish television broadcast in two parts is here (in Danish):

One of the issues in Global Kidney Exchange is covering not only the initial costs of patients and donors who aren't insured in the U.S., but also arranging for insurance in case of complications.  This story gives some insight into the kinds of complications that can arise, even if only rarely.  Part of the market design issue is how to cover these costs in a systematic rather than an ad hoc way.  In the present case, the costs of caring for the donor and recipient when they returned home was taken care of by the Danish healthcare system, even though  it had declined to help with the transplant in the U.S.

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