Germany legalizes kidney exchange !!

 Axel Ockenfels forwards the good news. He writes: "It passed! The Bundestag voted today to permit kidney exchange in Germany. The CDU/CSU, SPD, and Greens voted in favor." 

 (More steps will have to be taken before kidney exchanges occur regularly in Germany, but this is a giant step forward.) 

 Here's the official announcement:

Parlament weitet Regeln zur Lebendorganspende aus  

Parliament expands rules on living organ donation 

"On Thursday, March 26, 2026, the Bundestag expanded the possibility of living kidney donations to increase the circle of possible organ donors and organ recipients. A corresponding bill of the Federal Government "to amend the Transplantation Act – Amendment of the regulations on living organ donation and further amendments" (21/3619) in the version amended by the Health Committee was adopted by the majority of the CDU/CSU, SPD and Bündnis 90/Die Grünen against the votes of the parliamentary group Die Linke, with the AfD abstaining. In the future, this will also enable so-called cross-over living kidney donations between different couples. 

...

"Despite numerous initiatives to promote organ donation, there has been no trend reversal so far. At the end of 2024, around 6,400 people were waiting for a donor kidney, according to the information. At the same time, the number of kidney transplants fell to 2,075. A total of 253 patients died in 2024 who were on the waiting list for a kidney.

"Opening up further therapy options
"Therefore, it is important to open up further therapy options that have long been established internationally. The goal of countering the danger of organ trafficking remains decisive in the amendment of the regulations, according to the draft.

"In the future, living kidney donations will be possible "crosswise" by another organ donor partner in the case of immunologically incompatible organ donor couples. The organ donor couples do not have to know each other. However, the so-called close relationship of the respective incompatible partners should remain mandatory. 

"Principle of subsidiarity is repealed
"The so-called principle of subsidiarity, according to which organ removal from living persons is only permitted if no suitable organ from a deceased donor is available, will be repealed. Non-directed anonymous kidney donation, i.e. a donation to an unknown person, is also made possible. The donor should have no influence on the recipient.

"The plan is to establish a program for the mediation and implementation of crossover living kidney donation, including anonymous kidney donation. A center for the placement of kidneys is to be established. The conciliation procedure is laid down by law.

"Care in the transplant center mandatory
"Mandatory independent psychosocial counselling and evaluation of donors before a donation will be introduced. In addition, care in the transplant center will be mandatory throughout the entire donation process.

"If a living kidney donor later falls ill himself and needs a kidney transplant, this should be taken into account when arranging kidneys donated postmortem. Institutions that remove tissue postmortem should be able to be connected to the Register for Declarations of Organ and Tissue Donation (OGR) so that they can clarify for themselves whether there is a willingness to donate tissue in a potential donation case." 

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It's been a long campaign, and Axel and a number of others played a critical, tireless role, both in public and in private consultation with lawmakers and interested parties. It's notable that the legislation looks forward to allowing nondirected donors (not every European kidney exchange program does.) It's also notable that the current bill expects that compatible pairs will not be eligible to participate in kidney exchange to seek a better match. That's a battle that hasn't yet been won, despite the fact that compatible pairs are important in a number of ways in U.S. kidney exchange.

Still, this is a significant victory in a campaign that has been going on for at least a decade. I may have written the first German newspaper editorial on the need to legalize kidney exchange in Germany, almost exactly ten years ago:

Thursday, March 17, 2016  German organ transplant law should be amended or reinterpreted to allow kidney exchange: my op-ed in Der Tagesspiegel

 

Here's one of the more recent editorials, which I was privileged to coauthor with Ockenfels and two other heroes (or in this case heroines) of this struggle, Agnes Cseh and Christine Kurschat:

Monday, September 9, 2024  Anticipating kidney exchange in Germany in the Frankfurter Allgemeine Zeitung

 Der Volkswirt Hoffnung durch Tausch  by Ágnes Cseh, Christine Kurschat, Axel Ockenfels und Alvin E. Roth

 

 There will be more steps to take to establish effective regulations and institutions to make kidney exchange readily available in Germany, but this is a big step in that direction.

Abundant, the movie about nondirected kidney donors, is now available for streaming.

 Abundant, the movie about (mostly) non-directed (mostly) kidney donors (but also some livers), is now available for streaming.

You can get it at https://abundantmovie.com/ 

You can see all my posts about the movie Abundant here. 

Ed Peskowitz (1944-2026)

 After an eventful life, with major accomplishments in business and philanthropy, Ed Peskowitz succumbed to kidney failure this week.  I met him only after he had turned to philanthropy, and after he had received a kidney transplant.

Here's his obit in the Washington Jewish Week: 

Edwin Peskowitz 

"Ed was an extremely generous man who touched the lives of many. Over the course of his life, he and his wife supported local educational initiatives, such as the I Have a Dream Foundation and the SEED Public Charter School. Ed was passionate about promoting Middle Eastern peace and supported numerous causes in the region aimed at building understanding between various cultures and religions and he created the Friendship Games to encourage this among young athletes. He was a supporter of the Anti-Defamation League, the United States Holocaust Memorial Museum and the University of Maryland.

Ed suffered from renal disease and was given the gift of life by an altruistic kidney donation in 2019. Ed devoted the last years of his life to creating and supporting philanthropic efforts, such as the Alliance for Paired Kidney Donation, Kidney Transplant Collaborative and Kidneys for Communities, to encourage living kidney donation and improve matches between potential donors and recipients." 

 

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."   

A rare -directed- deceased donor kidney transplant

 Most organ transplants come from deceased donors, and the vast majority of these deceased donor organs are allocated by a regulated system of national waiting lists. That is, the organs of a deceased donor go to strangers in need. In contrast, most transplants from living donors (of kidneys and livers) are direct donations from someone healthy enough to donate to someone who they know.*  Living donations are also different in that they can be planned well in advance, while deceased donations have to be hastily arranged following a death.

But it is legal, and sometimes possible, for the next of kin of a deceased potential donor to direct an organ donation to someone they know who needs a transplant.  This will only take place if the potential recipient is available on short notice, and if the donor organ is compatible with the recipient.  So it's a rare event: the next of kin need to know someone in need, and the transplant has to turn out to be feasible.

But rare events happen, and the NYT reports on just such a story:

A Man Who Shunned Cheap Sentiment Left a Gift for Others: Life  By Dan Barry

"Informed that her 55-year-old brother would never regain consciousness, Darlene Costello made the heartbreaking decision to have him removed from his ventilator — only to learn, seconds before it was time, that Brendan was a registered organ donor.

"Once Ms. Costello calmed down — why wasn’t this known before? — she came to embrace the news of her brother’s final selfless act. She also knew someone who desperately needed a kidney. Calls were made, tests done, overwhelming odds overcome."

...

" His lungs went to a woman in Tennessee, his right kidney to a man in Pennsylvania. And his left kidney was received by Ms. Costello’s mentor and employer, Dr. Sylvio Burcescu, 62, whose ability to run his Westchester County clinic had been hampered by a rare kidney disease requiring dialysis."

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*Nondirected living donors can also start chains of kidney exchange. 

Heroines of organ donation

Last week I had the opportunity to see a screening of the movie Abundant, about non-directed organ donors, who have donated organs to strangers.  Here is a snapshot of me and two of the donors who tell their story in the film, Laurie Lee and Laura Diaz Moore.  They are both pretty inspiring.

 

 See also this story.

Kidneys and Controversies at Mt. Sinai hospital

 I gave a talk yesterday at Mt. Sinai hospital. They had encouraged me to talk about controversies, which I happily did.  They were a sympathetic audience (although the majority of their last five speakers would not have been:)

 

 

 

The End Kidney Deaths Act is reintroduced to the 119th Congress

 Resolved: lets be generous to nondirected kidney donors

H.R.2687 - To amend the Internal Revenue Code of 1986 to provide a refundable tax credit for non-directed living kidney donations.
119th Congress (2025-2026) |
Sponsor:    Rep. Malliotakis, Nicole [R-NY-11] (Introduced 04/07/2025)
Committees:    House - Ways and Means; Energy and Commerce 

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Earlier

Tuesday, January 21, 2025 The debate over compensating organ donors is heating up

Tuesday, August 13, 2024 End Kidney Deaths Act intoduced in Congress

 

 

Kidney exchange: the donor stories, and the movie Abundant

 I'm learning a bit about movie production by following the progress of the movie Abundant, which is about to have a pre-release premier.  Here is the trailer (sponsored by the APKD), and the press release.

Here's the trailer:  https://vimeo.com/1048377579

 

And here's the press release:

LOS ANGELES--(BUSINESS WIRE)--ABUNDANT, a documentary film that follows the unbelievable events surrounding extreme altruists who donated kidneys to complete strangers, has set its world premiere in Hollywood at The Directors Guild of America Theater Complex on March 1, 2025. The event is presented by OneLegacy Inspires Hollywood and The National Kidney Donation Organization (NKDO) as a kickoff to National Kidney Month. OneLegacy Inspires Hollywood champions authentic and accurate storytelling that highlight the power of organ, eye and tissue donation and transplantation.

“ABUNDANT moves us beyond a mindset of scarcity, reminding us of our shared humanity and connection”

The film’s world premiere is an entertainment industry event to showcase the often-miraculous stories connected to altruistic acts such as living kidney donation. “ABUNDANT moves us beyond a mindset of scarcity, reminding us of our shared humanity and connection,” said Sarah E. Fahey, Chair of OneLegacy Inspires Hollywood. “Through a powerful emotional journey of joy, grief, and hope, the film keeps audiences engaged from start to finish—and lingers long after the credits roll. OneLegacy Inspires Hollywood is thrilled to partner with NKDO and Maitri River Productions to premiere this impactful story during National Kidney Month here in Hollywood. This is the movie Los Angeles, and the world, needs right now,” Fahey added.

The choice of Los Angeles for ABUNDANT’s world premiere was in part inspired by the widespread acts of generosity, kindness and abundance displayed by the Los Angeles community during the recent wildfires. “One thing became obvious to me about abundance and altruism when I was making ABUNDANT,” said Director Donald Griswold. “Acts of abundance or generosity don’t have to be life-saving or dramatic to impact another person’s life meaningfully. We’re all fascinated by the non-directed kidney donors who give a kidney to a stranger, but viewers walk away from the film realizing that small acts and everyday kindnesses make an important impact, too. We saw that in so many ways in LA these last few weeks. We had to show ABUNDANT for the first time here and now.”

National Kidney Donation Organization supports ABUNDANT as part of an effort to gain more attention for kidney donation stories. “We are proud to have a hand in sharing this life-affirming message of hope and goodness with the people of LA, and with all those across the country who might be inspired by it,” said Emily Polet-Monteserro, Executive Director, National Kidney Donation Organization. “This compelling film uses the vehicle of kidney donation to encourage the audience to consider what it means for them to live fully and with love toward everyone, including strangers.”

ABUNDANT includes interviews with 2012 Nobel Prize Laureate Alvin Roth, PhD, Freakonomics Radio host Stephen Dubner, author and researcher Abigail Marsh, PhD, and business leader in the field of system change, Tynesia Boyea-Robinson among other notable personalities. The film features first-hand stories of non-directed kidney donation (where a person donates a kidney to a complete stranger) in a never-before-seen way of telling stories. 

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Earlier:

Tuesday, September 24, 2024

Abundant: a moving documentary about living organ donors

Exceptional altruism: living organ donors who donate twice

 Some living donors are moved to do it twice: first a kidney, and then later a liver, or the other way around. It appears that this is trending upwards in the last few years.

 

Second Time Around: Increased Rate of Living Donation From Repeat Organ Donors  by Carolyn N Sidoti 1, Kelly Terlizzi 1, Conor Donnelly 1, Ian S Jaffe 2, Jennifer D Motter 1, Benjamin Philosophe 3, Reed T Jenkins 3, Sarah Hussain 3, Pedro Colon 2, Amit D Tevar 4, Bonnie E Lonze 1, Babak J Orandi 1 5, Macey L Levan 1, Dorry L Segev 1 6, Allan B Massie, Clin Transplant,  2025 Jan; 39(1):
 https://onlinelibrary.wiley.com/doi/10.1111/ctr.70049

"Abstract
Introduction: Some living organ donors will decide to donate again at a later date. Evidence has indicated that this practice may have increased in recent years. We evaluated the incidence and outcomes of this practice to inform counseling of potential repeat donors.

Methods: Using SRTR data from 1994 to 2023, we identified 220 repeat living donors and their 415 recipients. We constructed donor comparison groups using weighting by the odds. We described clinical and lab results at 6 months, 1 year, and 2 years post-donation separately for kidney-second donors and liver-second donors. We compared all-cause graft failure for their recipients with those of comparison donors.

Results: The annual count of repeat living donors increased from 5 in 2018 to 25 in 2019 (p < 0.001). Of 220 donors, 159 were liver-second donors (72.3%) and 55 were kidney-second donors (25.0). The percentage of nondirected donations increased from 30.5% at first donation to 53.2% at second donation (p < 0.001). Liver-second donors had one death approximately 2.5 years post-donation. Seventeen were re-admitted and 20 experienced complications requiring an interventional procedure or re-operation. Among kidney-second donors, no deaths, re-admissions, or post-donation complications were reported. Post-donation outcomes in both groups were comparable when evaluated against organ-specific comparison donors. Recipients of repeat living donors experienced graft survival similar to recipients of comparison donors.

Conclusions: Repeat living donation may be a safe practice for carefully selected living donors in the short term; however, long term safety is unknown. Outcomes for recipients are similar to recipients of comparison donors."

...

"The first reported instance of repeat living donation occurred in 1981 when a living kidney donor went on to donate a segment of their pancreas 2.3 years later [1].  

Kidney exchange chain at Ohio State--a gift transforms 20 lives

 Here's a recent big kidney exchange chain, begun by a nondirected donor, involving patient-donor pairs all at OSU's medical center

The Columbus Dispatch has the story. (If I had written the headline, it would have said "transforming 20 lives," since many of the donors I've met have also been transformed.)

Ohio State Wexner sets record-breaking kidney 'donation chain,' transforming 10 lives   by Samantha Hendrickson

"On Dec. 13, Samantha Fledderjohann donated one of her kidneys to a stranger in need, and in the process, transformed 10 lives.

The 46-year-old was the first of a record-breaking "chain" of 20 surgeries over a two-day period at the Ohio State University Wexner Medical Center Comprehensive Transplant Center, both to remove and transplant kidneys from 10 living donors to 10 recipients. That means 10 people now have another chance to live more of their lives better and longer with a healthy kidney.

...

"The transplant swap begins with an "altruistic non-directed" donor like Fledderjohann, who saw a need for more kidney donors, and felt an internal pull to donate even without someone in mind

...

"The "chain reaction" continued, thanks to individuals like Carnahan staying on OSU's donor list despite not being a match for a loved one, instead extending that offer to a stranger in need.

...

"According to the Organ Procurement and Transplantation Network, there are 104,840 people on the transplant waitlist and 90,506 need a kidney in the United States, and 2,079 of them live in Ohio. Ohio State’s transplant center has performed more than 8,500 kidney transplants since 1967."