1
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Agrawal D, Ariga KK, Saigal S. Novel 4-way simultaneous liver paired exchange: Is it generalizable? Am J Transplant 2023; 23:2013-2014. [PMID: 37586458 DOI: 10.1016/j.ajt.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/10/2023] [Accepted: 08/10/2023] [Indexed: 08/18/2023]
Affiliation(s)
- Dhiraj Agrawal
- Department of Gastroenterology and Hepatology, PACE Hospitals, Hyderabad, Telangana, India.
| | | | - Sanjiv Saigal
- Department of Hepatology and Liver Transplant, Centre for Liver and Biliary Sciences, Centre of Gastroenterology, Hepatology and Endoscopy, Max Super Speciality Hospital, Saket, New Delhi, India
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2
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Yaghoubi M, Cressman S, Edwards L, Shechter S, Doyle-Waters MM, Keown P, Sapir-Pichhadze R, Bryan S. A Systematic Review of Kidney Transplantation Decision Modelling Studies. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:39-51. [PMID: 35945483 DOI: 10.1007/s40258-022-00744-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/19/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Genome-based precision medicine strategies promise to minimize premature graft loss after renal transplantation, through precision approaches to immune compatibility matching between kidney donors and recipients. The potential adoption of this technology calls for important changes to clinical management processes and allocation policy. Such potential policy change decisions may be supported by decision models from health economics, comparative effectiveness research and operations management. OBJECTIVE We used a systematic approach to identify and extract information about models published in the kidney transplantation literature and provide an overview of the status of our collective model-based knowledge about the kidney transplant process. METHODS Database searches were conducted in MEDLINE, Embase, Web of Science and other sources, for reviews and primary studies. We reviewed all English-language papers that presented a model that could be a tool to support decision making in kidney transplantation. Data were extracted on the clinical context and modelling methods used. RESULTS A total of 144 studies were included, most of which focused on a single component of the transplantation process, such as immunosuppressive therapy or donor-recipient matching and organ allocation policies. Pre- and post-transplant processes have rarely been modelled together. CONCLUSION A whole-disease modelling approach is preferred to inform precision medicine policy, given its potential upstream implementation in the treatment pathway. This requires consideration of pre- and post-transplant natural history, risk factors for allograft dysfunction and failure, and other post-transplant outcomes. Our call is for greater collaboration across disciplines and whole-disease modelling approaches to more accurately simulate complex policy decisions about the integration of precision medicine tools in kidney transplantation.
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Affiliation(s)
- Mohsen Yaghoubi
- Department of Pharmacy Practice, Mercer University College of Pharmacy, Atlanta, USA
| | - Sonya Cressman
- Faculty of Health Sciences, Simon Fraser University, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Louisa Edwards
- School of Population and Public Health, University of British Columbia, Vancouver, V6T 1Z3, Canada
| | - Steven Shechter
- Sauder School of Business, University of British Columbia, Vancouver, Canada
| | - Mary M Doyle-Waters
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada
| | - Paul Keown
- Department of Medicine, Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | | | - Stirling Bryan
- School of Population and Public Health, University of British Columbia, Vancouver, V6T 1Z3, Canada.
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3
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Roth AE, Marino IR, Ekwenna O, Dunn TB, Paloyo SR, Tan M, Correa-Rotter R, Kuhr CS, Marsh CL, Ortiz J, Testa G, Sindhwani P, Segev DL, Rogers J, Punch JD, Forbes RC, Zimmerman MA, Ellis MJ, Rege A, Basagoitia L, Krawiec KD, Rees MA. Global kidney exchange should expand wisely. Transpl Int 2021; 33:985-988. [PMID: 32430941 DOI: 10.1111/tri.13656] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 05/13/2020] [Indexed: 12/17/2022]
Affiliation(s)
| | | | | | - Ty B Dunn
- University of Pennsylvania, Philadelphia, PA, USA
| | - Siegfredo R Paloyo
- Philippine General Hospital, University of the Philippines, Manila, Philippines.,St. Luke's Medical Center, Manila, Philippines
| | | | - Ricardo Correa-Rotter
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | | | | | | | - Jeffrey Rogers
- Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | | | | | | | | | - Aparna Rege
- Duke University Medical Center, Durham, NC, USA
| | - Laura Basagoitia
- General Regional Hospital No 1, Dr. Carlos Macgregor Sánchez Navarro, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | - Michael A Rees
- University of Toledo, Toledo, OH, USA.,Alliance for Paired Kidney Donation, Perrysburg, OH, USA
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4
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Kute VB, Patel HV, Modi PR, Rizvi SJ, Shah PR, Engineer DP, Banerjee S, Meshram HS, Butala BP, Modi MP, Gandhi S, Patel AH, Mishra VV, Roth AE, Kopke JE, Rees MA. Non-simultaneous kidney exchange cycles in resource-restricted countries without non-directed donation - a prospective single-center cohort study. Transpl Int 2021; 34:669-680. [PMID: 33527555 DOI: 10.1111/tri.13833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 08/31/2020] [Accepted: 01/25/2021] [Indexed: 12/20/2022]
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.
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Affiliation(s)
- Vivek B Kute
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Himanshu V Patel
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Pranjal R Modi
- Department of Urology and Transplantation, IKDRC-ITS, Ahmedabad, India
| | - Syed J Rizvi
- Department of Urology and Transplantation, IKDRC-ITS, Ahmedabad, India
| | - Pankaj R Shah
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Divyesh P Engineer
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Subho Banerjee
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Hari Shankar Meshram
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Bina P Butala
- Department of Anesthesia, IKDRC-ITS, Ahmedabad, India
| | | | - Shruti Gandhi
- Department of Radiology, IKDRC-ITS, Ahmedabad, India
| | | | | | | | | | - Michael A Rees
- Alliance for Paired Kidney Donation, Perrysburg, OH, USA.,University of Toledo Medical Center, Toledo, OH, USA
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5
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Bray M, Wang W, Rees MA, Song PXK, Leichtman AB, Ashby VB, Kalbfleisch JD. KPDGUI: An interactive application for optimization and management of a virtual kidney paired donation program. Comput Biol Med 2019; 108:345-353. [PMID: 31054501 DOI: 10.1016/j.compbiomed.2019.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 03/11/2019] [Accepted: 03/12/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND OBJECTIVES The aim in kidney paired donation (KPD) is typically to maximize the number of transplants achieved through the exchange of donors in a pool comprising incompatible donor-candidate pairs and non-directed (or altruistic) donors. With many possible options in a KPD pool at any given time, the most appropriate set of exchanges cannot be determined by simple inspection. In practice, computer algorithms are used to determine the optimal set of exchanges to pursue. Here, we present our software application, KPDGUI (Kidney Paired Donation Graphical User Interface), for management and optimization of KPD programs. METHODS While proprietary software platforms for managing KPD programs exist to provide solutions to the standard KPD problem, our application implements newly investigated optimization criteria that account for uncertainty regarding the viability of selected transplants and arrange for fallback options in cases where potential exchanges cannot proceed, with intuitive resources for visualizing alternative optimization solutions. RESULTS We illustrate the advantage of accounting for uncertainty and arranging for fallback options in KPD using our application through a case study involving real data from a paired donation program, comparing solutions produced under different optimization criteria and algorithmic priorities. CONCLUSIONS KPDGUI is a flexible and powerful tool for offering decision support to clinicians and researchers on possible KPD transplant options to pursue under different user-specified optimization schemes.
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Affiliation(s)
- Mathieu Bray
- University of Michigan, Department of Biostatistics, Ann Arbor, MI, USA; University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor, MI, USA.
| | - Wen Wang
- University of Michigan, Department of Biostatistics, Ann Arbor, MI, USA; University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor, MI, USA
| | - Michael A Rees
- University of Toledo Medical Center, Department of Urology, Toledo, OH, USA; Alliance for Paired Donation, Inc., Maumee, OH, USA
| | - Peter X-K Song
- University of Michigan, Department of Biostatistics, Ann Arbor, MI, USA; University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor, MI, USA
| | | | - Valarie B Ashby
- University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor, MI, USA
| | - John D Kalbfleisch
- University of Michigan, Department of Biostatistics, Ann Arbor, MI, USA; University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor, MI, USA
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6
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Stepkowski SM, Mierzejewska B, Fumo D, Bekbolsynov D, Khuder S, Baum CE, Brunner RJ, Kopke JE, Rees SE, Smith C, Ashlagi I, Roth AE, Rees MA. The 6-year clinical outcomes for patients registered in a multiregional United States Kidney Paired Donation program - a retrospective study. Transpl Int 2019; 32:839-853. [PMID: 30848501 DOI: 10.1111/tri.13423] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 12/11/2018] [Accepted: 03/04/2019] [Indexed: 01/10/2023]
Abstract
We examined what happened during a 6-year period to 1121 end-stage renal disease patients who registered with their willing/incompatible living donors for kidney exchanges with the Alliance for Paired Donation (APD). Of all patients, 65% were transplanted: 37% in kidney paired donation (APD-KPD, APD-other-KPD); 10% with compatible live donors (APD-LD); and 18% with deceased donors (APD-DD). The remaining patients were withdrawn (sick/died/others; 15%), or were still waiting (20%). For those patients with a cPRA 0-94%, 72% received a transplant. In contrast, only 49% of very highly sensitized (VHS; cPRA 95-100%) were transplanted. Of the VHS patients, 50% were transplanted by KPD/APD-LD while 50% benefited through prioritization of deceased donors in the modified kidney allocation system (KAS introduced in 2014). All APD transplanted groups had similar death-censored 4-year graft survivals as their relevant Organ Procurement and Transplantation Network (OPTN) groups. It is noteworthy that VHS graft and patient survival results were comparable to less sensitized and nonsensitized patients. All patients should be encouraged to search for compatible donors through different options. Expanding the donor pool through KPD and the new KAS of the OPTN increases the likelihood of transplantation for VHS patients.
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Affiliation(s)
- Stanislaw M Stepkowski
- Department of Medical Microbiology and Immunology, University of Toledo Medical Center, Toledo, OH, USA.,The Alliance for Paired Donation, Maumee, OH, USA
| | - Beata Mierzejewska
- The Alliance for Paired Donation, Maumee, OH, USA.,Department of Urology, University of Toledo Medical Center, Toledo, OH, USA
| | - David Fumo
- Department of Urology, University of Toledo Medical Center, Toledo, OH, USA
| | - Dulat Bekbolsynov
- Department of Medical Microbiology and Immunology, University of Toledo Medical Center, Toledo, OH, USA
| | - Sadik Khuder
- Department of Medical Microbiology and Immunology, University of Toledo Medical Center, Toledo, OH, USA
| | - Caitlin E Baum
- Department of Medical Microbiology and Immunology, University of Toledo Medical Center, Toledo, OH, USA
| | - Robert J Brunner
- Department of Urology, University of Toledo Medical Center, Toledo, OH, USA
| | | | - Susan E Rees
- The Alliance for Paired Donation, Maumee, OH, USA
| | - Connie Smith
- The Alliance for Paired Donation, Maumee, OH, USA
| | - Itai Ashlagi
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA
| | - Alvin E Roth
- Department of Economics, Stanford University, Stanford, CA, USA
| | - Michael A Rees
- Department of Medical Microbiology and Immunology, University of Toledo Medical Center, Toledo, OH, USA.,The Alliance for Paired Donation, Maumee, OH, USA.,Department of Urology, University of Toledo Medical Center, Toledo, OH, USA
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7
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Holscher CM, Jackson K, Thomas AG, Haugen CE, DiBrito SR, Covarrubias K, Gentry SE, Ronin M, Waterman AD, Massie AB, Wang JG, Segev DL. Temporal changes in the composition of a large multicenter kidney exchange clearinghouse: Do the hard-to-match accumulate? Am J Transplant 2018; 18:2791-2797. [PMID: 30063811 PMCID: PMC6287934 DOI: 10.1111/ajt.15046] [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] [Received: 05/31/2018] [Revised: 07/24/2018] [Accepted: 07/25/2018] [Indexed: 01/25/2023]
Abstract
One criticism of kidney paired donation (KPD) is that easy-to-match candidates leave the registry quickly, thus concentrating the pool with hard-to-match sensitized and blood type O candidates. We studied candidate/donor pairs who registered with the National Kidney Registry (NKR), the largest US KPD clearinghouse, from January 2012-June 2016. There were no changes in age, gender, BMI, race, ABO blood type, or panel-reactive antibody (PRA) of newly registering candidates over time, with consistent registration of hard-to-match candidates (59% type O and 38% PRA ≥97%). However, there was no accumulation of type O candidates over time, presumably due to increasing numbers of nondirected type O donors. Although there was an initial accumulation of candidates with PRA ≥97% (from 33% of the pool in 2012% to 43% in 2014, P = .03), the proportion decreased to 17% by June 2016 (P < .001). Some of this is explained by an increase in the proportion of candidates with PRA ≥97% who underwent a deceased donor kidney transplantation (DDKT) after the implementation of the Kidney Allocation System (KAS), from 8% of 2012 registrants to 17% of 2015 registrants (P = .02). In this large KPD clearinghouse, increasing participation of nondirected donors and the KAS have lessened the accumulation of hard-to-match candidates, but highly sensitized candidates remain hard-to-match.
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Affiliation(s)
| | - Kyle Jackson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alvin G. Thomas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christine E. Haugen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sandra R. DiBrito
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Karina Covarrubias
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sommer E. Gentry
- Department of Mathematics, United States Naval Academy, Annapolis, MD
| | | | - Amy D Waterman
- David Geffen School of Medicine at UCLA, Kidney Transplant Program, Los Angeles, CA, USA,Terasaki Research Institute, Los Angeles, CA, USA
| | - Allan B. Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | | | - Dorry 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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8
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Malvezzi P, Jouve T, Noble J, Rostaing L. Desensitization in the Setting of HLA-Incompatible Kidney Transplant. EXP CLIN TRANSPLANT 2018; 16:367-375. [PMID: 29863455 DOI: 10.6002/ect.2017.0355] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The number of kidney transplant candidates is increasing sharply. Among them, at least 20% are HLA sensitized. For these patients, in the setting of both living- and deceased-donor kidney transplant, we may face donor-specific alloantibodies at pretransplant. In such cases, the microlymphocytotoxicity crossmatch may or may not be positive. Kidney transplant with donor-specific antibodies at pretransplant is known as HLA-incompatible transplant. At present, we can use many methods to ensure that the kidney transplant is successful, provided that the recipient is desensitized before or after transplant. In this paper, we review the various strategies available for desensitization of HLA-incompatible kidney transplant recipients and the long-term outcomes.
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Affiliation(s)
- Paolo Malvezzi
- From the Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation, Centre Hospitalier Universitaire Grenoble-Alpes, Grenoble, France
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9
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Ashlagi I, Bingaman A, Burq M, Manshadi V, Gamarnik D, Murphey C, Roth AE, Melcher ML, Rees MA. Effect of match-run frequencies on the number of transplants and waiting times in kidney exchange. Am J Transplant 2018; 18:1177-1186. [PMID: 29087017 DOI: 10.1111/ajt.14566] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 09/24/2017] [Accepted: 10/16/2017] [Indexed: 01/25/2023]
Abstract
Numerous kidney exchange (kidney paired donation [KPD]) registries in the United States have gradually shifted to high-frequency match-runs, raising the question of whether this harms the number of transplants. We conducted simulations using clinical data from 2 KPD registries-the Alliance for Paired Donation, which runs multihospital exchanges, and Methodist San Antonio, which runs single-center exchanges-to study how the frequency of match-runs impacts the number of transplants and the average waiting times. We simulate the options facing each of the 2 registries by repeated resampling from their historical pools of patient-donor pairs and nondirected donors, with arrival and departure rates corresponding to the historical data. We find that longer intervals between match-runs do not increase the total number of transplants, and that prioritizing highly sensitized patients is more effective than waiting longer between match-runs for transplanting highly sensitized patients. While we do not find that frequent match-runs result in fewer transplanted pairs, we do find that increasing arrival rates of new pairs improves both the fraction of transplanted pairs and waiting times.
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Affiliation(s)
- Itai Ashlagi
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA
| | - Adam Bingaman
- Texas Transplant Institute, Methodist Specialty and Transplant Hospital, San Antonio, TX, USA
| | | | | | | | - Cathi Murphey
- Southwest Immunodiagnostics Laboratory, San Antonio, TX, USA
| | - Alvin E Roth
- Department of Economics, Stanford University, Stanford, CA, USA
| | - Marc L Melcher
- Department of Surgery, Stanford University, Stanford, CA, USA
| | - Michael A Rees
- University of Toledo, Toledo, OH, USA.,Alliance for Paired Donation, Perrysburg, OH, USA
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10
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Bray M, Wang W, Song PXK, Kalbfleisch JD. Valuing Sets of Potential Transplants in a Kidney Paired Donation Network. STATISTICS IN BIOSCIENCES 2018; 10:255-279. [PMID: 30220933 PMCID: PMC6136670 DOI: 10.1007/s12561-018-9214-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 02/21/2018] [Indexed: 11/30/2022]
Abstract
In kidney paired donation (KPD), incompatible donor-candidate pairs and non-directed (also known as altruistic) donors are pooled together with the aim of maximizing the total utility of transplants realized via donor exchanges. We consider a setting in which disjoint sets of potential transplants are selected at regular intervals, with fallback options available within each proposed set in the case of individual donor, candidate or match failure. We develop methods for calculating the expected utility for such sets under a realistic probability model for the KPD. Exact expected utility calculations for these sets are compared to estimates based on Monte Carlo samples of the underlying network. Models and methods are extended to include transplant candidates who join KPD with more than one incompatible donor. Microsimulations demonstrate the superiority of accounting for failure probability and fallback options, as well as candidates joining with additional donors, in terms of realized transplants and waiting time for candidates.
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Affiliation(s)
- Mathieu Bray
- Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | - Wen Wang
- Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | - Peter X-K Song
- Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | - John D Kalbfleisch
- Department of Biostatistics, University of Michigan, Ann Arbor, MI. Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, MI
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11
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Tenenbaum EM. Swaps and Chains and Vouchers, Oh My!: Evaluating How Saving More Lives Impacts the Equitable Allocation of Live Donor Kidneys. AMERICAN JOURNAL OF LAW & MEDICINE 2018; 44:67-118. [PMID: 29764323 DOI: 10.1177/0098858818763812] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Live kidney donation involves a delicate balance between saving the most lives possible and maintaining a transplant system that is fair to the many thousands of patients on the transplant waiting list. Federal law and regulations require that kidney allocation be equitable, but the pressure to save patients subject to ever-lengthening waiting times for a transplant has been swinging the balance toward optimizing utility at the expense of justice. This article traces the progression of innovations created to make optimum use of a patient's own live donors. It starts with the simplest - direct donation by family members - and ends with voucher donations, a very recent and unique innovation because the donor can donate 20 or more years before the intended recipient is expected to need a kidney. In return for the donation, the intended recipient receives a voucher that can be redeemed for a live kidney when it is needed. Other innovations that are discussed include kidney exchanges and list paired donation, which are used to facilitate donor swaps when donor/recipient pairs have incompatible blood types. The discussion of each new innovation shows how the equity issues build on each other and how, with each new innovation, it becomes progressively harder to find an acceptable balance between utility and justice. The article culminates with an analysis of two recent allocation methods that have the potential to save many additional lives, but also affirmatively harm some patients on the deceased donor waiting list by increasing their waiting time for a life-saving kidney. The article concludes that saving additional lives does not justify harming patients on the waiting list unless that harm can be minimized. It also proposes solutions to minimize the harm so these new innovations can equitably perform their intended function of stimulating additional transplants and extending the lives of many transplant patients.
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Affiliation(s)
- Evelyn M Tenenbaum
- Professor of Law, Albany Law School and Professor of Bioethics, Albany Medical College. Special thanks to Darren O'Connor, David Conti, Timothy Lytton, Nadia Sawicki, Jed Adam Gross, and Bridget Cuccia for their editing suggestions and invaluable comments. I owe everlasting gratitude to my fantastic research assistants Erin Kilmer, Emily Phillips, and Alexandra Newcomb for their tireless research assistance and enormous help in getting this article out the door. This article is dedicated to my sister Judy Tenenbaum, the strongest person I know, to thank her for her consistent support, wonderful sense of humor, and unique ability to give me perspective
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12
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Wang W, Bray M, Song PXK, Kalbfleisch JD. A Look-Ahead Strategy for Non-Directed Donors in Kidney Paired Donation. STATISTICS IN BIOSCIENCES 2017; 9:453-469. [PMID: 29225712 DOI: 10.1007/s12561-016-9155-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
While there is a growing need for kidney transplants to treat end stage kidney disease, the supply of transplantable kidneys is in serious shortage. Kidney paired donation (KPD) programs serve as platforms for candidates with willing but incompatible donors to assess the possibility of exchanging donors, thus opening up new transplant opportunities for these candidates. In recent years, non-directed (or altruistic) donors (NDDs) have been incorporated into KPD programs beginning chains of transplants that benefit many candidates. In such programs, making optimal decisions in transplant exchange selection is of critical importance. With the aim of improving the selection of chains beginning with an NDD, this paper introduces a look-ahead multiple decision strategy to select chains, that are easy to extend in the future. Simulation studies are adopted to assess performance of this strategy. Taking into account the extensibility of chains increases the number of realized transplants.
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Affiliation(s)
- Wen Wang
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, MI
| | - Mathieu Bray
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, MI
| | - Peter X-K Song
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, MI
| | - John D Kalbfleisch
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, MI
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13
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Brunner R, Fumo D, Rees M. Novel Approaches to Expanding Benefits from Living Kidney Donor Chains. CURRENT TRANSPLANTATION REPORTS 2017. [DOI: 10.1007/s40472-017-0141-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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14
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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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15
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Melcher ML, Roberts JP, Leichtman AB, Roth AE, Rees MA. Utilization of Deceased Donor Kidneys to Initiate Living Donor Chains. Am J Transplant 2016; 16:1367-70. [PMID: 26833680 PMCID: PMC4844828 DOI: 10.1111/ajt.13740] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 01/20/2016] [Accepted: 01/24/2016] [Indexed: 01/25/2023]
Abstract
We propose that some deceased donor (DD) kidneys be allocated to initiate nonsimultaneous extended altruistic donor chains of living donor (LD) kidney transplants to address, in part, the huge disparity between patients on the DD kidney waitlist and available donors. The use of DD kidneys for this purpose would benefit waitlisted candidates in that most patients enrolled in kidney paired donation (KPD) systems are also waitlisted for a DD kidney transplant, and receiving a kidney through the mechanism of KPD will decrease pressure on the DD pool. In addition, a LD kidney usually provides survival potential equal or superior to that of DD kidneys. If KPD chains that are initiated by a DD can end in a donation of an LD kidney to a candidate on the DD waitlist, the quality of the kidney allocated to a waitlisted patient is likely to be improved. We hypothesize that a pilot program would show a positive impact on patients of all ethnicities and blood types.
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Affiliation(s)
| | - John P. Roberts
- Surgery, University of California at San Francisco, San Francisco, CA
| | | | | | - Michael A. Rees
- Urology, University of Toledo Medical Center, Toledo, OH,Alliance for Paired Donation, Maumee, OH
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16
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Affiliation(s)
- Lionel P E Rostaing
- From Clinique de Néphrologie, Unité de Transplantation Rénale, Centre Hospitalier Universitaire (CHU) Grenoble-Alpes, La Tronche (L.P.E.R., P.M.), and INSERM Unité 563, Federative Structure of Bio-Medical Research of Toulouse, CHU Purpan, and Université Toulouse III Paul Sabatier, Toulouse (L.P.E.R.) - all in France
| | - Paolo Malvezzi
- From Clinique de Néphrologie, Unité de Transplantation Rénale, Centre Hospitalier Universitaire (CHU) Grenoble-Alpes, La Tronche (L.P.E.R., P.M.), and INSERM Unité 563, Federative Structure of Bio-Medical Research of Toulouse, CHU Purpan, and Université Toulouse III Paul Sabatier, Toulouse (L.P.E.R.) - all in France
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17
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Tenenbaum EM. BARTERING FOR A COMPATIBLE KIDNEY USING YOUR INCOMPATIBLE, LIVE KIDNEY DONOR: LEGAL AND ETHICAL ISSUES RELATED TO KIDNEY CHAINS. AMERICAN JOURNAL OF LAW & MEDICINE 2016; 42:129-169. [PMID: 27263265 DOI: 10.1177/0098858816644719] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Kidney chains are a recent and novel method of increasing the number of available kidneys for transplantation and have the potential to save thousands of lives. However, because they are novel, kidney chains do not fit neatly within existing legal and ethicalframeworks, raising potential barriers to their full implementation. Kidney chains are an extension of paired kidney donation, which began in the United States in 2000. Paired kidney donations allow kidney patients with willing, but incompatible, donors to swap donors to increase the number of donor/recipient pairs and consequently, the number of transplants. More recently, transplant centers have been using non-simultaneous, extended, altruistic donor ("NEAD") kidney chains--which consist of a sequence of donations by incompatible donors--to further expand the number of donations. This Article fully explains paired kidney donation and kidney chains and focuses on whether NEAD chains are more coercive than traditional kidney donation to a family member or close friend and whether NEAD chains violate the National Organ Transplant Act's prohibition on the transfer of organs for valuable consideration.
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