A discussion of kidney exchange in Brazil began with this letter to the editor, describing how kidney exchange (aka kidney paired donation) could increase transplantation in Brazil:
Bastos, J., Mankowski, M., Gentry, S., Massie, A., Levan, M., Bisi, C., Stopato,C., Freesz, T., Colares, V., Segev, D. and Ferreira, G., 2021. Kidney paired donation in Brazil-A single center perspective. Transplant International: Official Journal of the European Society for Organ Transplantation.
"Kidney paired donation (KPD) represents a strategy for increasing the number of LDKT, offering an incompatible donor/recipient pair, the chance to exchange with another pair in the same situation [4]. In Brazil, KPD is still prohibited by law. We designed a study to show mathematically how KPD could increase LDKT in a single center in Brazil.
Several comments followed in a forum.. The name of the forum is ""Kidney Paired Donation is necessary in Brazil." But not everyone agrees with that headline.
In particular, a letter to the editor from Mario Abbud-Filho & Valter Duro Garcia concludes that there are too many poor people in Brazil to allow kidney exchange:
"We do not condemn the KPD strategy, but we disagree that it should be proposed in the actual Latin American context, where such great socioeconomic disparities do exist and could fuel organ trafficking and commerce."
That letter drew this rejoinder, in favor of kidney exchange by Marcelo Perosa:
"We do not understand the rationale behind the claim that KPD could stimulate organ trafficking and trade if the LD of an eventual KPD swap would be submitted to the same steps and rigor currently used for unrelated LDKT to be approved.
"The acceptance of KPD is growing around the world. It brings a potential technological development with advanced algorithms and softwares, unites clinicians, surgeons, immunologists in fruitful discussions and analysis of match runs, expanding and exchanging knowledge among multidisciplinary teams that currently work separately. KPD still has the beauty of not dividing, but joining efforts among different centers since the more groups participating, the more patients in the database and more matches are found.
"The main goal of KPD was to increase the chance of KT among highly sensitized (HS) patients, preventing the onerous treatment of desensitization. For a country with more limited economic resources like Brazil, KPD makes perfect sense for always contemplating compatible, cheaper, and more successful transplants."
And a final summation from two of the authors of the original paper:
Bastos, Juliana, and Gustavo Ferreira. "Kidney Paired Donation in Brazil-It is time to talk about it." Transplant International: Official Journal of the European Society for Organ Transplantation (2021), 01 Oct 2021, 34(10):1757-1758 DOI: 10.1111/tri.14025 PMID: 34431143
"The history of kidney transplantation in Brazil began in 1965 when the first related living donor transplant. Since then, Brazil has established a public programme and now has the most extensive public kidney transplantation system in the world. Brazil has established a regulated, standardized and ethical organ procurement system, created awareness of transplantation in physicians and the public, upgraded facilities and standardized medical care, and enforced legislation for transplantation.
"The Aguascalientes document establishes that KPD and altruistic donation are acceptable. Its final recommendations also say that the country must provide access to transplantation based on ethical considerations and protect the most vulnerable population for a healthy transplant system [4]. We are failing to do that when we have a system that does not contemplate highly sensitized recipients, as shown by a recent Brazilian analysis: highly sensitized patients (PRA > 98%) had lower transplant rates (3.7% vs. 31.2%) and higher mortality (HR: 1.09, P = 0.05) in the waitlist when compared to nonsensitized patients [1]."
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