Opposition to irresponsible global kidney exchange

    Francis L. Delmonico & Nancy L. Ascher

    AJT logo

    Epub; 2 August 2017

    Letter to the Editor:

    We are writing in opposition to the proposed “global kidney exchange” that would solicit living donors from economically underdeveloped countries such as Mexico, the Philippines, Kenya, India, and Ethiopia. The experience of representatives from countries such as India and Mexico reported at the Vatican Pontifical Academy of Sciences Summit on the topic of organ trafficking in February 2017 was very clear—these locations are sites of organ trafficking. The capacity of this project to ensure that targeted donors in underdeveloped countries will be emotionally related, free of coercion, and fully informed of risk is not feasible when the culture is so experienced with organ sales. Vendors will be readily solicited to sell their kidneys despite the “global kidney exchange” disclaimer that “commercial interest should be carefully ruled out in such kind of exchange with careful selection.”

    In a pending application to the European Commission for funding, the “global kidney exchange” proposes “to match one incompatible pair with another and a scoring rubric developed to find the best possible match, utilizes each nation’s unique assets.” The notion of a living donor as a marketable “unique asset” in the context of soliciting “willing” individuals to undergo nephrectomy in underdeveloped countries is an unacceptable concept. To target economically underdeveloped countries to solicit donors when there is no assurance about the ultimate care of the living organ donor (or the absence of coercion) is unethical. What deliverable framework is being provided about the well-being of this exchange donor in an underdeveloped country that may have reliable medical care at 5, 15, and more years after nephrectomy? The risk of kidney failure in the lifetime of a donor is dependent on proper care. Successful programs of paired donation in the United States, Korea, or Europe do not exploit economic deprivation to identify matches and, again, have the capacity to care for the living donor in the long term.Targeting economically underdeveloped countries to solicit donors is an unacceptable tactic when there may be no reliable/available long-term care of the donor.

    The inadequacy of using a program of “global kidney exchange” in, for example, India becomes evident in a current description of paired donation in India: “The leading cause of morbidity and mortality after kidney transplantation in India is Infection. Better HLA matched kidney transplantation for the compatible pairs will result in better long term outcome and need of re-transplantation which is common cause of sensitization.” To link kidney exchange in descriptive sequenced sentences to a reduction in infection—as a validation of such an exchange program—should elicit a responsible concern of implementing “global kidney exchange” in an underdeveloped country,especially in India, where organ trafficking is reported regularly in the media. Finally, the “global kidney exchange” program has suggested there will be oversight by organizations such as the World Health Organization (WHO) and The Transplantation Society (TTS). That contention is not correct; both the WHO and TTS oppose the introduction of this “global kidney exchange” program.

    Link to letter here

    Epistemic Communities, Human Rights, and the Global Diffusion of Legislation against the Organ Trade

    F. Amahazion

    Social Sciences

    2016; Epub October 27


    Over the past several decades, over 100 countries have passed legislation banning commercial organ transplantation. What explains this rapid, global diffusion of laws? Based on qualitative data from in-depth interviews, historical analysis, and secondary sources, this paper explores the role played by the medical epistemic community and human rights in the global spread of laws against the organ trade. In addition to shaping, guiding, and influencing norms and approaches to transplantation, the epistemic community has been instrumental in the development of various resolutions, policy initiatives, recommended practices, statements, legislation, and model laws. Moreover, the epistemic community helped position the organ trade as an issue of societal and global importance, and it persistently encouraged states to undertake actions, such as implementing legislation, to combat the organ trade. Critically, the epistemic community’s efforts against the organ trade incorporated the concepts of human rights, integrity, and dignity, which had diffused globally and become institutionalized in the period after WWII.

    Read the complete article courtesy of Social Sciences here.

    Providing coverage for the unique life‐long health care needs of living kidney donors within the framework of financial neutrality

    J.S. Gill, F. L. Delmonico, S. Klarenbach, A. M. Capron

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    2016; Epub November 26


    Organ donation should neither enrich nor impose financial burdens on donors. We describe the scope of health care required for all living kidney donors that reflects contemporary understanding of long-term donor health outcomes, propose an approach to identify donor health conditions which should be covered within the framework of financial neutrality, and propose strategies to pay for this care. Despite the Affordable Care Act in the United States, donors continue to have inadequate coverage for important health conditions that are either donation related or may compromise post-donation kidney function. Amendment of Medicare regulations is needed to clarify that surveillance and treatment of conditions that may compromise post-donation kidney function following donor nephrectomy will be covered without expense to the donor. In other countries lacking health insurance for all residents, sufficient data exist to allow creation of a compensation fund or donor insurance policies to ensure appropriate care. Providing coverage for donation-related sequelae as well as care to preserve post-donation kidney function ensures protection against the financial burdens of health care encountered by donors throughout their lifetime. Providing coverage for this care should thus be cost-effective even without considering the health care cost savings that occur in living donor transplant recipients.

    Click here to read the article (subscription required).

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