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Deceased Donor–initiated Chains: First Report of a Successful Deliberate Case and Its Ethical Implications. Transplantation 2019; 103:2196-2200. [DOI: 10.1097/tp.0000000000002645] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Abstract
Kidney exchanges were developed to match kidney failure patients with willing but incompatible donors to other donor-patient pairs. Finding a match in a large candidate pool can be modeled as an integer program. However, these exchanges accumulate participants with characteristics that increase the difficulty of finding a match and, therefore, increase patients’ waiting time. Therefore, we sought to fine-tune the formulation of the integer program by more accurately assigning priorities to patients based on their difficulty of matching. We provide a detailed formulation of prioritized kidney exchange and propose a novel prioritization algorithm. Our approach takes advantage of the global knowledge of the donor-patient compatibility within a pool of pairs and calculates an iterative, paired match power (iPMP) to represent the donor-patient pairs’ abilities to match. Monte Carlo simulation shows that an algorithm using the iPMP reduces the waiting time more than using paired match power (PMP) for the difficult-to-match pairs with hazard ratios of 1.3480 and 1.1100, respectively. Thus, the iPMP may be a more accurate assessment of the difficulty of matching a pair in a pool than PMP is, and its use may improve matching algorithms being used to match donors and recipients.
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Affiliation(s)
- Wenhao Liu
- Salesforce.com, Inc
- Department of Surgery, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Marc L. Melcher
- Department of Surgery, School of Medicine, Stanford University, Palo Alto, CA, USA
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Ross LF, Rodrigue JR, Veatch RM. Ethical and Logistical Issues Raised by the Advanced Donation Program "Pay It Forward" Scheme. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2018; 42:518-536. [PMID: 28922906 DOI: 10.1093/jmp/jhx018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The advanced donation program was proposed in 2014 to allow an individual to donate a kidney in order to provide a voucher for a kidney in the future for a particular loved one. In this article, we explore the logistical and ethical issues that such a program raises. We argue that such a program is ethical in principle but there are many logistical issues that need to be addressed to ensure that the actual program is fair to both those who do and do not participate in this program.
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Affiliation(s)
| | - James R Rodrigue
- Beth Israel Deaconess Medical Center, Boston, Massachussetts, USA
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Rees MA, Dunn TB, Kuhr CS, Marsh CL, Rogers J, Rees SE, Cicero A, Reece LJ, Roth AE, Ekwenna O, Fumo DE, Krawiec KD, Kopke JE, Jain S, Tan M, Paloyo SR. Kidney Exchange to Overcome Financial Barriers to Kidney Transplantation. Am J Transplant 2017; 17:782-790. [PMID: 27992110 DOI: 10.1111/ajt.14106] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 10/23/2016] [Accepted: 10/24/2016] [Indexed: 01/25/2023]
Abstract
Organ shortage is the major limitation to kidney transplantation in the developed world. Conversely, millions of patients in the developing world with end-stage renal disease die because they cannot afford renal replacement therapy-even when willing living kidney donors exist. This juxtaposition between countries with funds but no available kidneys and those with available kidneys but no funds prompts us to propose an exchange program using each nation's unique assets. Our proposal leverages the cost savings achieved through earlier transplantation over dialysis to fund the cost of kidney exchange between developed-world patient-donor pairs with immunological barriers and developing-world patient-donor pairs with financial barriers. By making developed-world health care available to impoverished patients in the developing world, we replace unethical transplant tourism with global kidney exchange-a modality equally benefitting rich and poor. We report the 1-year experience of an initial Filipino pair, whose recipient was transplanted in the United states with an American donor's kidney at no cost to him. The Filipino donor donated to an American in the United States through a kidney exchange chain. Follow-up care and medications in the Philippines were supported by funds from the United States. We show that the logistical obstacles in this approach, although considerable, are surmountable.
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Affiliation(s)
- M A Rees
- University of Toledo Medical Center, Toledo, OH.,Alliance for Paired Donation, Perrysburg, OH
| | - T B Dunn
- University of Minnesota, Minneapolis, MN
| | - C S Kuhr
- Virginia Mason Medical Center, Seattle, WA
| | - C L Marsh
- Scripps Green Hospital, La Jolla, CA
| | - J Rogers
- Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - S E Rees
- University of Toledo Medical Center, Toledo, OH.,Alliance for Paired Donation, Perrysburg, OH
| | - A Cicero
- ABC Medical Center, Mexico City, Mexico
| | - L J Reece
- Alliance for Paired Donation, Perrysburg, OH
| | - A E Roth
- Stanford University, Stanford, CA
| | - O Ekwenna
- University of Toledo Medical Center, Toledo, OH.,Alliance for Paired Donation, Perrysburg, OH
| | - D E Fumo
- University of Toledo Medical Center, Toledo, OH.,Alliance for Paired Donation, Perrysburg, OH
| | | | - J E Kopke
- Alliance for Paired Donation, Perrysburg, OH
| | - S Jain
- University of Toledo Medical Center, Toledo, OH
| | - M Tan
- Piedmont Hospital, Atlanta, GA
| | - S R Paloyo
- University of the Philippines-Philippine General Hospital, Manila, Philippines.,St. Luke's Medical Center-Global City, Manila, Philippines
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Current status on the evaluation and management of the highly sensitized kidney transplant recipient. Curr Opin Nephrol Hypertens 2016; 24:570-5. [PMID: 26418060 DOI: 10.1097/mnh.0000000000000172] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW In light of the recent changes to the kidney allocation system (KAS) and the observed increase in the rate of transplantation of the highly sensitized kidney transplant candidate, the evaluation and care of this population is a timely topic. RECENT FINDINGS In its first year, the new KAS has already realized one goal of improving the chances of transplanting the most highly sensitized patients in the waiting list. This has brought to the forefront the need for recipient readiness in this special population, as well as the need for histocompatibility labs and kidney transplant programs to align themselves with each other, and also with the requirements of the United Network for Organ Sharing, and increase proficiency in testing and data interpretation. This manuscript is a review of the literature as well as practice patterns as they relate to the changes in KAS and the observed outcome since the activation of the new KAS, with the ultimate goal of aiding in the development of a more unified approach in the care of this specialized population which will allow for interdisciplinary and cross centre dialogue to optimize long term care and outcomes. SUMMARY Here we will review the changes to the KAS as they affect the highly sensitized kidney transplant recipient, and additional considerations in the evaluation and management of these patients.
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Affiliation(s)
- W Liu
- Department of Management Science & Engineering, Stanford University, Stanford, CA
| | | | - M L Melcher
- Department of Surgery, Stanford University, Palo Alto, CA
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Gentry SE, Segev DL. The Best-Laid Schemes of Mice and Men Often Go Awry; How Should We Repair Them? Am J Transplant 2015; 15:2539-40. [PMID: 26382203 DOI: 10.1111/ajt.13414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 06/02/2015] [Indexed: 01/25/2023]
Affiliation(s)
- S E Gentry
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Mathematics, United States Naval Academy, Annapolis, MD
| | - D L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
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