Long kidney exchange in Ahmedabad, India

Vivek Kute writes with the news:
IKDRC completes India’s longest cross-transplant chain

"Institute of Kidney Diseases and Research Center, Institute of Transplantation Sciences (IKDRC-ITS) Ahmedabad, India is pleased to share the news of an exciting milestone for the patients with end stage renal disease with incompatible living kidney donors. Our transplant team has completed longest Kidney Exchange transplant chain in India as well as Asia involving 10 donor-recipients pairs over 5 days in January 2020. Two kidney transplant surgeries were performed each on 4, 6 and 7 January, 3 transplants on 8 January and last kidney transplant was completed on 22 January 2020.
...
". The success of this program can be attributed to the selflessness of the more than 500 family members who have stepped forward to be living organ donors. Dr Vivek Kute Professor of Nephrology maintains the single center registry of incompatible pairs. Dr Vivek Kute  and his team is greatful to Prof. Michael Rees and Prof. Alvin Roth for providing the Alliance for Paired Donations software for computer allocation at free of cost. Transplant team members are Dr Vineet Mishra, Dr Pranjal Modi, Dr Himanshu Patel, Dr Jamal Rizvi, Dr Vivek Kute, Dr Bina Butala and others."

A transplant center in India has done 300 kidney exchange transplants

Here's the article, whose first author is Dr. Vivek Kute, of the Faculty of Nephrology and Transplantation, Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences ,
(IKDRC-ITS) Ahmedabad , India

Transpl Int. 2017 Mar 20. doi: 10.1111/tri.12956. [Epub ahead of print]

Impact of Single-Centre Kidney Paired Donation Transplantation to Increase the Donor Pool in India.

Kute VB1, Patel HV1, Shah PR1, Modi PR2, Shah VR3, Rizvi SJ2, Pal BC2, Shah PS1, Modi MP3, Butala BP3, Wakhare PS1, Varyani UT1, Shinde SG1, Ghodela VA1, Kasat GS1, Patil MV1, Patel JC1, Kumar DP1, Trivedi VB4, Patel MH4, Trivedi HL1.

Author information

Abstract

In a living donor kidney transplantation (LDKT) dominated transplant programme, kidney paired donation (KPD) may be a cost-effective and valid alternative strategy to increase LDKT in countries with limited resources where deceased donation kidney transplantation (DDKT) is in the initial stages. Here, we report our experience of 300 single-centre KPD transplantations to increase LDKT in India. Between January 2000 and July 2016, 3616 LDKT and 561 DDKT were performed at our transplantation centre, 300 (8.3%) using KPD. The reasons for joining KPD among transplanted patients were ABO incompatibility (n=222), positive cross match (n=59) and better matching (n=19). A total of 124 two-way (n=248), 14 three-way (n=42), one 4-way (n=4) and one 6-way exchange (n=6) yielded 300 KPD transplants. Death-censored graft and patient survival were 96% (n=288) and 83.3% (n=250), respectively. The mean serum creatinine was 1.3 mg/dl at a follow-up of 3±3 years. We credit the success of our KPD programme to maintaining a registry of incompatible pairs, counselling on KPD, a high-volume LDKT programme and teamwork. KPD is legal, cost effective and rapidly growing for facilitating LDKT with incompatible donors. This study provides large-scale evidence for the expansion of single-centre LDKT via KPD when national programmes do not exist. This article is protected by copyright. All rights reserved.

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

Here's a related recent article by Dr. Kute:

World J Transplant. 2017 Feb 24;7(1):64-69. doi: 10.5500/wjt.v7.i1.64.

International kidney paired donation transplantations to increase kidney transplant of O group and highly sensitized patient: First report from India.

Kute VB1, Patel HV1, Shah PR1, Modi PR1, Shah VR1, Rizvi SJ1, Pal BC1, Shah PS1, Wakhare PS1, Shinde SG1, Ghodela VA1, Varyani UT1, Patel MH1, Trivedi VB1, Trivedi HL1.

Author information

Abstract

AIM:

To report the first international living related two way kidney paired donation (KPD) transplantation from India which occurred on 17th February 2015 after legal permission from authorization committee.

METHODS:

Donor recipient pairs were from Portugal and India who were highly sensitized and ABO incompatible with their spouse respectively. The two donor recipient pairs had negative lymphocyte cross-matching, flow cross-match and donor specific antibody in two way kidney exchange with the intended KPD donor. Local KPD options were fully explored for Indian patient prior to embarking on international KPD.

RESULTS:

Both pairs underwent simultaneous uneventful kidney transplant surgeries and creatinine was 1 mg/dL on tacrolimus based immunosuppression at 11 mo follow up. The uniqueness of these transplantations was that they are first international KPD transplantations in our center.

CONCLUSION:

International KPD will increases quality and quantity of living donor kidney transplantation. This could be an important step to solving the kidney shortage with additional benefit of reduced costs, improved quality and increased access for difficult to match incompatible pairs like O blood group patient with non-O donor and sensitized patient. To the best of our knowledge this is first international KPD transplantation from India.

77 Kidney Exchange transplants in 2015 at one transplant center in India

I received the following cheerful news from Dr. Vivek Kute at the Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences ,
(IKDRC-ITS) Ahmedabad , India

 Kidney Paired Donation (KPD) Transplantation Activity At Single Center In Institute Of Kidney Diseases And Research Center And Dr. H L Trivedi Institute Of Transplantation Sciences , (IKDRC-ITS) Ahmedabad , India

Kute VB , Patel HV, Shah PR, Vanikar AV, Modi PR, Shah VR , Varyani UT, Wakhare PS ,  Shinde  SG,  Godhela VA, Shah PS , MK Shah , Gattani VS ,Shah JH, Wadhai KG , Trivedi VB, Patel MH, Trivedi HL.

1) We have performed the largest number of KPD Transplantations (77 patients from 1 Jan 2015 to 1 Jan 2016) in our single center and to the best of our knowledge this is largest number for KPD transplants in single center in one year in the World. KPD constitutes 25% of living donor kidney transplant (LDKT) in 2015.

2) We have performed 274 KPD Transplantations in Our Single Center from Year 2000- 2015 and total 231 KPD Transplantations from Year 2011-2015

3) We Have Performed First Non-Simultaneous Domino Chain Transplant of 6 ESRD Patients and 6 Donors in Single Center in August 2015.

4) We Have Performed First International KPD Transplant on 17 Feb 2015.

5) In The Year 2013, we have performed 56 Kidney Paired Donation Transplantations in our single center. KPD constitutes 15.8% of LDKT in 2013.

6) In The Year 2014, we have performed 56 Kidney Paired Donation Transplantations in our single center. KPD constitutes 18.1% of LDKT in 2014.

7) We Have Performed Ten KPD Transplantations on World Kidney Day 2013 in Single Day in Our Single Center on 14 March 2013.

8) We Have Performed Successful Three-Way KPD Transplantation: First Time in India on 13 February 2013.

9) We Have Performed Successful Three-Way KPD Transplantation in Combination with Desensitization Protocol: First Time in India on 6 May 2014.

Under Mentorship of Prof. HL Trivedi, Vivek Kute is mainly focused on expanding donor pool and kidney-paired donation (KPD) transplantation. 

Correspondence Address

Dr.Vivek Kute. 

MBBS, MD, FCPS, DM Nephrology (Gold Medalist), FASN

Associate Professor , Nephrology and Transplantation, Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences , (IKDRC-ITS) Ahmedabad , India

(M) : +919099927543  

Email: drvivekkute@rediffmail.com  

Website : www.ikdrc-its.org

Kidney exchange in India: progress, then Covid

 Here's a paper reporting, among other things, a long kidney exchange cycle in India.  But Covid has put a temporary halt to all that.

Paired Kidney Exchange in India: Future Potential and Challenges Based on the Experience at a Single Center  by Kute, Vivek B. MD, DM, FASN, FRCP1; Patel, Himanshu V. MD, DNB1; Modi, Pranjal R. MS, DNB2; Rizvi, Syed J. MS, MCh2; Engineer, Divyesh P. MD, DM1; Banerjee, Subho MD, DM1; Butala, Bina P. MD3; Gandhi, Shruti MD4; Patel, Ansy H. MBBS5; Mishra, Vineet V. MS  Transplantation: May 2021 - Volume 105 - Issue 5 - p 929-932  doi: 10.1097/TP.0000000000003421

But now Covid is taking a toll. Dr. Kute writes in an email that transplantation has been on hold in Gujarat since April. He says "we had cumulative 225 kidney transplant recipients with PCR confirmed COVID-19 in our single center. Over all mortality in transplants population 10% and much higher in dialysis."

Here's hoping that vaccine production ramps up and Covid falls away in India and the rest of the world soon.

**********

I have quite a number of posts following the work of Dr. Kute and his colleagues in Ahmedabad.

Non-Simultaneous Kidney Exchange Cycles in India: new design, in Transplant International by Kute and Rees et al.

 Perhaps the biggest part of the ongoing design of kidney exchange around the world involves adapting to constantly changing local conditions in patient and donor populations, and the prevailing laws, regulations and medical situation.  In India, where non-directed donation is illegal (except in Kerala), this means that some patients can be transplanted only if long exchange cycles are possible.  In most of the world, the requirement that the surgeries in a cycle be performed simultaneously has prevented this.

The paper below, organized by two of the world's most innovative transplant doctors, Vivek Kute and Mike Rees (first and last authors, in the medical manner), demonstrates a path forward in India. The paper reports 17 very carefully arranged and conducted non-simultaneous (and non-anonymous) kidney exchange cycles, accomplishing 67 transplants. These were performed at the  Trivedi Institute of Transplantation Sciences  (using our software:).

Vivek B. Kute, Himanshu V. Patel, Pranjal R. Modi, Sayyad J. Rizvi, Pankaj R. Shah, Divyesh P Engineer, Subho Banerjee, Hari Shankar Meshram, Bina P. Butala, Manisha P. Modi, Shruti Gandhi, Ansy H. Patel, Vineet V. Mishra, Alvin E. Roth, Jonathan E. Kopke, Michael A. Rees, “Non-simultaneous kidney exchange cycles in resource-restricted countries without non-directed donation,” Transplant International, February 2021.

Abstract: Recent reports suggest that bridge-donor reneging is rare (1.5%) in non-simultaneous kidney exchange chains. However, in developing countries, the non-directed donors who would be needed to initiate chains are unavailable, and furthermore, limited surgical space and resources restrain the feasibility of simultaneous kidney exchange cycles. Therefore, the aim of this study was to evaluate the bridge-donor reneging rate during non-simultaneous kidney exchange cycles (NSKEC) in a prospective single-center cohort study (n=67). We describe the protocol used to prepare co-registered donor-recipient pairs for non-simultaneous surgeries, in an effort to minimize the reneging rate. In addition, in order to protect any recipients who might be left vulnerable by this arrangement, we proposed the use of standard criteria deceased-donor kidneys to rectify the injustice in the event of any bridge-donor reneging.  We report 17 successful NSKEC resulting in 67 living-donor kidney transplants (LDKT) using  23 bridge-donors without donor renege  and  no intervening pairs became unavailable. We propose that NSKEC could increase LDKT, especially for difficult-to-match sensitized pairs (25 of our 67 pairs) in countries with limited transplantation resources. Our study confirms that NSKEC can be safely performed with careful patient-donor selection and non-anonymous kidney exchanges.

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

Some previous posts:

Saturday, February 1, 2020

Long kidney exchange in Ahmedabad, India

Wednesday, May 22, 2019

Kidney exchange in India: the legal framework

Tuesday, May 21, 2019

Robot-assisted kidney transplantation in Ahmedabad, India.

Ten kidney exchange transplants on World Kidney Day in Ahmedabad, India

Here's the link:

Clinical Studies

Ten kidney paired donation transplantation on World Kidney Day 2013: raising awareness and time to take action to increase donor pool

Posted online on August 12, 2013. (doi:10.3109/0886022X.2013.823997)

Vivek B. Kute¹, Aruna V. Vanikar², Pankaj R. Shah¹, Manoj R. Gumber¹, Himanshu V. Patel¹, Divyesh P. Engineer¹, Pranjal R. Modi³, S.J. Rizvi³, Veena R. Shah⁴, Manisha P. Modi⁴, Kamal V. Kanodia², and Hargovind L. Trivedi¹

¹Department of Nephrology and Clinical Transplantation,

²Department of Pathology, Laboratory Medicine, Transfusion Services and Immunohematology,

³Department of Urology and Transplantation, and

⁴Anesthesia and Critical Care, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS),

Ahmedabad

, India

Address correspondence to

Dr. Vivek Kute

, Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases & Research Centre, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC- ITS), Civil Hospital Campus,

Ahmedabad 380016, Gujarat

, India. Tel.: +91 79 22687000; Fax: +91 79 2268 5454; E-mail: drvivekkute@rediffmail.com

Abstract

Background: Kidney paired donation (KPD) is feasible for any center that performs living related donor renal transplantation (LRDRTx). Lack of awareness, counseling and participation are important hurdles in KPD patients with incompatible donors. Materials and methods: This is an institutional review board approved study of 10 ESRD patients who consented to participate in the KPD transplantation at our center. All the surgeries were carried out on the same day at the same center on the occasion of World Kidney Day (WKD) (14 March 2013). All recipients had anatomic, functional and immunological similar donors. Results: KPD were performed to avoid blood group incompatibility (n = 8) or to avoid a positive crossmatch (n = 2). None of the patients experienced delayed graft function and surgical complications. At 3 month follow-up, median serum creatinine was 1 (range 0.6 to 1.25) mg/dL and two patients developed allograft biopsy-proven acute rejection and responded to antirejection therapy. Due to impact of our awareness activity, 20 more KPD patients are medically fit for transplantation and waiting for permission from the authorization committee before transplantation. Conclusion: This is a report of 10 simultaneous KPD transplantations in a single day in a single centre on WKD raising awareness of KPD. KPD is viable, legal and rapidly growing modality for facilitating LRDRTx for patients who are incompatible with their healthy, willing LRD.

Read More: http://informahealthcare.com/doi/abs/10.3109/0886022X.2013.823997

Kidney Paired Donation in Developing Countries: a Global Perspective

 Vivek Kute and his colleagues argue that one of the lessons from the developing world is that kidney exchange can save many lives, but may need to be organized differently in some ways than in the developed world.

Kidney Paired Donation in Developing Countries: a Global Perspective by Vivek B. Kute, Vidya A. Fleetwood, Sanshriti Chauhan, Hari Shankar Meshram, Yasar Caliskan, Chintalapati Varma, Halil Yazıcı, Özgür Akın Oto & Krista L. Lentine, Current Transplantation Reports (2023)  (here's a link that may provide better access]

Abstract

...

"Despite the advantages of KPD programs, they remain rare among developing nations, and the programs that exist have many differences with those of in developed countries. There is a paucity of literature and lack of published data on KPD from most of the developing nations. Expanding KPD programs may require the adoption of features and innovations of successful KPD programs. Cooperation with national and international societies should be encouraged to ensure endorsement and sharing of best practices.

Summary

KPD is in the initial stages or has not yet started in the majority of the emerging nations. But the logistics and strategies required to implement KPD in developing nations differ from other parts of the world. By learning from the KPD experience in developing countries and adapting to their unique needs, it should be possible to expand access to KPD to allow more transplants to happen for patients in need worldwide."

...

" Despite the advantages of KPD programs, they remain rare in the developing world, and the programs that exist have many differences with those of developed countries. Program structure is one of these differences: multi-center, regional, and national KPD programs (Swiss, Australia, Canada, Dutch, UK, USA) are more common in the developed than the developing world, whereas single center programs are more common

...

"kidney exchanges frequently take weeks to months to obtain legal permission in India despite the fact that only closely-related family members (i.e., parents, spouse, siblings, children, and grandparents) are allowed to donate a kidney [47].

...

"Protecting the privacy of a donor, including maintaining anonymity when requested, is common practice among developed countries but uncommon in developing nations. Anonymous allocation during KPD is a standard practice in the Netherlands, Sweden, and other parts of Europe, but this is not the case in countries such as India, Korea, and Romania [14, 48, 49]. In areas where anonymity is not maintained, the intended donor/recipient pair must meet and share medical information once a potential exchange is identified, but before formal allocation of pairs occurs. The original donor/ recipient pair may refuse the proposed exchange option for any reason and continue to be on the waitlist. In India, nonanonymous KPD allocation is standard practice and has the goal of increasing trust and transparency between the transplant team and the administrative team [14, 49]. Countries differ in philosophical approaches to optimizing trust and transparency, and objective data on most effective practices would benefit the global community."

********

Tomorrow I hope to have a few words to say about the equally unique situation in China.

######

Update:

Tuesday, September 19, 2023

Organ transplantation in China: in transition--and controversy about paying funeral costs

Kidney exchange in all its aspects: a view from India

Here's a survey that sees kidney exchange, and all the advances that have been made in how to use it to facilitate more transplants, as a force for making medicine more inclusive around the world.

Kidney exchange transplantation current status, an update and future perspectives
Vivek B Kute, Narayan Prasad, Pankaj R Shah, Pranjal R Modi
World J Transplant. Jun 28, 2018; 8(3): 52-60
Published online Jun 28, 2018. doi: 10.5500/wjt.v8.i3.52

Abstract: "Kidney exchange transplantation is well established modality to increase living donor kidney transplantation. Reasons for joining kidney exchange programs are ABO blood group incompatibility, immunological incompatibility (positive cross match or donor specific antibody), human leukocyte antigen (HLA) incompatibility (poor HLA matching), chronological incompatibility and financial incompatibility. Kidney exchange transplantation has evolved from the traditional simultaneous anonymous 2-way kidney exchange to more complex ways such as 3-way exchange, 4-way exchange, n-way exchange,compatible pair, non-simultaneous kidney exchange,non-simultaneous extended altruistic donor, never ending altruistic donor, kidney exchange combined with desensitization, kidney exchange combined with ABO incompatible kidney transplantation, acceptable mismatch transplant, use of A2 donor to O patients, living donor-deceased donor list exchange, domino chain, non-anonymous kidney exchange, single center, multicenter, regional, National, International and Global kidney exchange. Here we discuss recent advances in kidney exchanges such as International kidney exchange transplantation in a global environment, three categories of advanced donation program, deceased donors as a source of chain initiating kidneys, donor renege myth or reality, pros and cons of anonymity in developed world and (non-) anonymity in developing world, pros and cons of donor travel vs kidney transport, algorithm for management of incompatible donor-recipient pairs and pros and cons of Global kidney exchange. The participating transplant teams and donor-recipient pairs should make the decision by consensus about kidney donor travel vs kidney transport and anonymity vs non-anonymity in allocation as per local resources and logistics. Future of organ transplantation in resource-limited setting will be liver vs kidney exchange, a legitimate hope or utopia?"

An interesting section of the paper discusses different practices regarding anonymity in kidney exchange centers in different countries:

"PROS AND CONS OF ANONYMITY IN DEVELOPED WORLD AND (NON-) ANONYMITY IN DEVELOPING WORLD

There is disparity on standard practice of kidney exchange in developed and developing World in term of (non-) anonymity. There is variable practice on anonymity before and after surgery in different countries.

Conditional approach[38]: When the donor-recipient pairs give consent for meeting after surgery, they are allowed to meet each other after surgery in some countries such as the United States of America[39] and the United Kingdom[40]. In other countries, such as the Netherlands and Sweden[41], anonymity is absolute. Anonymity protects patients, donors and transplant hospital/ administration against the risks of revoking anonymity and prevents further commercialization of organs, and breach of patient donor privacy. An Ethical, Legal and Psychosocial Aspects of Organ Transplantation (ELPAT), a subsection of the European Society for Organ Transplantation reported that a conditional approach to anonymity should be possible after surgery[42]. Pronk et al[38] showed that most donor-recipient pairs who participated in anonymous donation process are in favour of a conditional approach to anonymity. Guidelines on how to revoke anonymity if both parties agree are needed and should include education about pros and cons of (non-) anonymity and a logistical plan on how, when, where, and by whom anonymity should be revoked.

Non-anonymous allocation[11,12]: Donor-recipient pairs are allowed to meet each other before allocation of donor for surgery and even after surgery. They can share medical reports of exchange donors before surgery and kidney transplant and donor surgery outcome after surgery. Donor-recipient pairs do not choose their match but donor-recipient pairs may decline a match or can withdraw from participation in the kidney exchange program at any time, for any reason. Non-anonymous allocation has the potential of commercialization of organs in case of compatible donor-recipient pairs along with breach in privacy of donor-recipient pairs. Kute et al[11,12] reported that donor-recipient pairs are willing for non-anonymous allocation process in single center study of 300 kidney exchange transplants in India. They reported that non-anonymity is more helpful in manual allocation in absence of computer software allocation which also increases trust between patients, donors and transplant hospital/administration and legal team. More long term prospective studies are required to explore the donor and recipient perspective on anonymity in living kidney donation in different socio-economic regions and countries."

Regarding Global Kidney Exchange they conclude:

"Global kidney exchange appears to provide life-saving kidney transplantation to poor donor-recipient pairs from developing countries that otherwise could die due to economic constrain[50-53]."

And here's their conclusion:

CONCLUSION

"Kidney exchange transplantation has increased living donor kidney transplantation for end stage renal disease patients with chronological incompatibility and financial incompatibility. The participating transplant teams and donor-recipient pairs should make the decision by consensus about kidney donor travel vs kidney transport and anonymity vs non-anonymity in allocation as per local resources and logistics. There is need of uniform algorithm for management of incompatible donor-recipient pairs."

TTS2022 Awards--Congratulations

 Today at TTS2022, prizes will be awarded.  One that I know is very well deserved, is to Dr. Vivek Kute, for his extraordinary achievements in kidney transplantation in India. Congratulations to all the prize winners.

I've followed Dr. Kute's work over the years in multiple posts.

Kidney exchange in India

Outcome of kidney paired donation transplantation to increase donor pool and to prevent commercial transplantation: a single-center experience from a developing country.

Kute VB, Gumber MR, Patel HV, Shah PR, Vanikar AV, Modi PR, Shah VR, Patel MP, Trivedi HL.

Source

Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Civil Hospital Campus, Asarwa, Ahmedabad, 380016, Gujarat, India, drvivekkute@rediffmail.com.

Abstract

BACKGROUND:

Economic constraints in operating an effective maintenance dialysis program leaves renal transplantation as the only viable option for end-stage renal disease patients in India. Kidney paired donation (KPD) is a rapidly growing modality for facilitating living donor (LD) transplantation for patients who are incompatible with their healthy, willing LD.

MATERIALS AND METHODS:

The aim of our study was to report a single-center feasibilities and outcomes of KPD transplantation between 2000 and 2012. We performed KPD transplants in 70 recipients to avoid blood group incompatibility (n = 56) or to avoid a positive crossmatch (n = 14).

RESULTS:

Over a mean follow-up of 2.72 ± 2.96 years, one-, five- and ten-year patient survival were 94.6, 81, 81 %, and death-censored graft survival was 96.4, 90.2, 90.2 %, respectively. Ten percent of patients were lost, mainly due to infections (n = 4). There was 14.2 % biopsy-proven acute rejection, and 5.7 % interstitial fibrosis with tubular atrophy eventually leading to graft loss.

CONCLUSION:

The incidences of acute rejection, patient/graft survival rates were acceptable in our KPD program and, therefore, we believe it should be encouraged. These findings are valuable for encouraging participation of KPD pairs and transplant centers in national KPD program. It should be promoted in centers with low-deceased donor transplantation. Our study findings are relevant in the context of Indian government amending the Transplantation of Human Organs Act to encourage national KPD program. To our knowledge, it is largest single-center report from India.

Practical market design makes policy recommendations (which can violate NBER publication policy)

The National Bureau of Economic Research (NBER) publishes a widely read series of working papers, before publication in refereed journals. They also distribute a list of papers that have been published in medical journals, since those journals don't allow prepublication in working papers.  For both these series the NBER has a rule against papers that make policy recommendations.

This is sometimes a problem for the field of market design, since practical market design is about finding ways to improve the operation of markets, which is a kind of policy advice. I encountered this recently with the two papers described below, published in medical journals, which apparently are too policy related: the policy being to save more lives by arranging more transplants, in this case of hearts and kidneys respectively. (Medical journals have their own conventions, but aren't opposed to advice on medical practice...)

I received the following email from the NBER, accompanied by a line of explanation for each paper.

The email began:

"I apologize for my belated response about your journal articles; while the subject matter is clearly vital, after review of the full-text, we determined that your articles make policy recommendations that are too specific for NBER’s policy on working papers (which we apply to papers in the article list)."

 It then continued by highlighting the offending sentences in each article:

1. Alyssa Power MD*, Kurt R. Sweat MA*, Alvin Roth PhD, John C. Dykes MD, Beth Kaufman MD, Michael Ma MD, Sharon Chen MD, MPH, Seth A. Hollander MD, Elizabeth Profita MD, David N Rosenthal MD, Lynsey Barkoff NP, Chiu-Yu Chen MD PhD, Ryan R. Davies MD, Christopher S. Almond MD, MPH, “Contemporary Pediatric Heart Transplant Waitlist Mortality,” Journal of the American College of Cardiology, Vol 84, no. 7, August 13, 2024: 620-632.https://www.sciencedirect.com/science/article/pii/S0735109724075624

"Policy language:  A more flexible allocation system that accurately reflects patient-specific risks and considers transplant benefit is urgently needed."

2. Vivek B. Kute, Himanshu V Patel, Subho Banerjee,Divyesh P Engineer, Ruchir B Dave, Nauka Shah, Sanshriti Chauhan ,Harishankar Meshram , Priyash Tambi  , Akash Shah, Khushboo Saxena,Manish Balwani , Vishal Parmar, Shivam Shah, Ved Prakash ,Sudeep Patel, Dev Patel, Sudeep Desai, Jamal Rizvi , Harsh Patel, Beena Parikh, Kamal Kanodia, Shruti Gandhi, Michael A Rees,  Alvin E Roth,  Pranjal Modi “Impact of single centre kidney-exchange transplantation to increase living donor pool in India: A cohort study involving non-anonymous allocation,”Nephrology, September 2024,https://onlinelibrary.wiley.com/doi/10.1111/nep.14380

"Policy language: We suggest stepwise progress to achieve multicentre, regional, State and then a National program. Ideally, there should be engagement by the National Organ & Tissue Transplant Organization and the World Health Organization. 

While we recommend simultaneous surgery for mDRPs in a single exchange, sometimes logistical aspects have necessitated non-simultaneous exchanges"

##########

Earlier posts:

Thursday, August 8, 2024  Pediatric Heart Transplants: rethinking the waitlist, by Power, Sweat...Almond et al.

 Wednesday, September 18, 2024 More on non-anonymous kidney exchange in India