The Global Kidney Exchange Programme

In my WSJ review of Al Roth’s excellent book Who Gets What—and Why I wrote about Roth’s proposal to extend the idea of kidney swaps globally:

It’s often the case that a living donor is willing to give a kidney to a loved one, but the loved one can’t accept it because of immunity mismatch. But if a pair of such mismatched donors could be found (call them A and A´ and B and B´), then perhaps a match could be found by a crisscross pairing: Donor A could give to recipient B´ and donor B could give to recipient A´, thus solving the mismatch problem and saving lives.

…Today such multi-way exchanges are becoming common….Mr. Roth, however, wants to go further….why not open U.S. transplants to the world? Imagine that A and A´ are Nigerian while B and B´ are American. Nigeria has virtually no transplant surgery or dialysis available, so in Nigeria patient A’ will die for certain. But if we offered a free transplant to him, and received a kidney for an American patient in return, two lives would be saved.

The plan sounds noble but expensive. Yet remember, Mr. Roth says, “removing an American patient from dialysis saves Medicare a quarter of a million dollars. That’s more than enough to finance two kidney transplants.” So offering a free transplant to the Nigerian patient can save money and lives.

It’s hard to think of a better example of gains from trade (or a better PR coup for the U.S. on the world stage).

Recently, Rees et al., (including Roth) announced the first such global kidney exchange:

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.

Naturally, some people aren’t happy because of “ethical” objections. Minerva, Savulescu and Peter Singer write in defense of the program:

Lurking behind all the arguments against the GKE is the assumption that people who are poor are incapable of autonomous choices. So, if they appear to choose to act in ways that benefit not only themselves, but people in HICs, they must have been coerced, exploited, or commodified.

…Poverty does not necessarily make a person unable to choose to donate a kidney to a loved one, nor does it make someone incapable of weighing the pros and cons of an option like that offered by the GKE. Poverty does narrow down the options available to people, and often forces them to settle for an option that is not as good as a wealthy person would choose. That, however, is irrelevant to the ethics of the GKE if that programme provides a better option to patients in LMICs who need a kidney than any other option currently available to them.

…It would be tragic if such misguided objections were to prevent the GKE from realising its potential to reduce suffering and save the lives of rich and poor patients alike.

Hat tip: Frank McCormick.

Comments

"It’s often the case that a living donor is willing to give a conscience to a loved one, but the loved one can’t accept it because of ideological mismatch. But if a pair of such mismatched donors could be found (call them A and A´ and B and B´), then perhaps a match could be found by a crisscross pairing: Donor A could give to recipient B´ and donor B could give to recipient A´, thus solving the mismatch problem and saving minds."

ideological mismatch is always a problem

Corbyn is a notorious communist. If he accedes to the prime minister position, an iron curtain will descend around the United Kingdom.

Thiago going Global.

Oh, no. I am Mr. St. James from Kent, in South East England.

I love it when Thiago gets so specific and instructional about his fake hometowns. Although nothing will beat the time he was pretending to be a doctor, and he said "I am from Chattanooga, which is a city in Tennessee."

Actually, Chattanooga IS a city in Tennessee.

Whooooosh.

The joke, Thiago, is that EVERYBODY KNOWS THAT, AND PEOPLE FROM CHATTANOOGA DON'T SPECIFY IT WHEN INTRODUCING THEMSELVES.

Consider that a ProTip. Carry on.

It is not that simple. Marginal Revolution is known to have a cosmopolitan readership. As a British, I can assure you I am sure many readers don't know where Chattanooga is or even what it is. Famous Looney Tunes character Yosemite Sam is known to have fought against the Yankees in Chattanooga, but not everyone has watched that episode.

Come, come. The Chattanooga choo-choo is world famous.

P.S. You probably meant "As a Briton ..."

P.P.S. There's a theory that the name "Thanet", part of Kent, is from the Phoenician, reflecting the activities of early traders. (Marginal Revolution approves of trade.) I sometimes wonder why the Phoenicians or Carthaginians didn't sail/row to Brazil. Do you have a view on the matter?

I know no Choo Choo.
I meant to write "British person". According to famous British dictionary Oxford Learner's Dictionary ( https://www.oxfordlearnersdictionaries.com/us/definition/english/british?q=British ), "Briton" "is used mainly in newspapers".

There is good reason to believe Brazil was discovered by the Phoenicians:

https://en.m.wikipedia.org/wiki/Theory_of_Phoenician_discovery_of_the_Americas#Possible_artifacts
https://babakfakhamzadeh.com/phoenicians-in-brazil/

Famous 17 th Century Portuguese writer/priest Antônio Vieira postulated that Saint Thomas moved to Brazil after Christ's Ressurection. Jews are Semite like the Phoenicians.

Brazil may have been known in the Antiquity, which may be the origin of many legends: https://en.m.wikipedia.org/wiki/Brasil_(mythical_island) .

Best thread of the day. Made me giggle.

There are Canada and Mexico on the other side of a beautiful walls. But, yeah...Nigeria.

Off topic (only partly so), but I don't recall the debate over Medicare coverage of dialysis. Why renal failure but not heart failure or leukemia or any other chronic condition? But that's an issue for another day. I represented a nephrologist who, along with several other physicians, created a kidney (and other organs) harvesting and transplant organization. It became a very large organization. One of their offices was in the Caribbean islands, which I assumed was an excuse to take trips to the islands at the expense of the organization, but it turned out that they did lots of harvesting down there. Friends of my nephrology client would tell stories of how my client would provide free services to poor dialysis patients pre-Medicare and how he would prevail upon the hospital to use the hospital to provide dialysis for those patients. My experience with the organization raised my awareness of the hard business of harvesting organs, and I got over the lengths the organization would go to find donors, dead or alive. It's a fact of life, life for those with renal failure.

Cool beans Alex.

Hey, just some friendly feedback, but the pop-ups in MRU are annoying and unecessary.

Roth's kidney EXCHANGE is an exchange, not an exchange of a kidney for cash. It helps poor recipients in other countries get a kidney.

“Transplantation is about giving the gift of life to very sick patients. Global Kidney Exchange (GKE) takes this a step further, by allowing transplant surgeons to give the gift of life to people around the world who are not only very sick and dying, but also too poor to afford the treatment necessary to live with damaged kidneys,” asserts Michael Rees, MD, PhD, professor of pathology at the University of Toledo in Ohio. As one of the founders of kidney exchange (KE), Dr. Rees partnered with economists, law professors and trusted international colleagues to create the GKE as a means for poor people from developing countries to donate and receive organs. “For most people in the world, poverty is the biggest barrier to transplantation,” he points out. “Global Kidney Exchange provides a sustainable strategy to help some of these patients overcome their financial barrier to a life‐saving transplant.” Here's a link about the GKE: https://onlinelibrary.wiley.com/doi/full/10.1111/ajt.14469

>some people aren’t happy because of “ethical” objections.

Ah yes, scare quotes. The hallmark of any self-important "economist."

Yes, the idea that poor people are irrational beings who don’t know what’s best for them is the basis of most bad policies involving poor people. And you see this on both sides—people on the left will argue that poor people working in bad jobs are being tricked and exploited such that these jobs should not exist, yet poor people who risk their lives to illegally immigrate to rich countries are acting rationally as their options at home are even worse so risky migration routes should remain open, while people on the right will argue the opposite.

When poor people do something, we should always presume that they are doing the best thing for them out of the options they have, and should not take any options away from poor people for “their own good.”

"the assumption that people who are poor are incapable of autonomous choices": especially if they are little brown chaps, or black. Then it's vital that their interests be determined by Western Lefties.

If A and B find themselves sexually incompatible, they might be helped along by gummint to find an A' and B' in a similar situation. Of course, A with B' and A' with B might not be an improvement. The ideal solution is to create a sex market where, not unlike a home mortgage market, where willing buyers and sellers can advertise for and find one another.

Alas, gummint continues to mess with most markets, outlawing them when it can or seriously hobbling them when it can't. The best way to find mortgages, mates and organs is abolish the role of gummint altogether. Like a breath of fresh air.

Thankfully once President Warren is elected and M4A is enacted we will be able to work with the rest of the civilized world to find donors. We can start with the extra organs of the 1% and the work our way through the rest of the deplorables.

#EndKidneyInequalityNow

Your Kidneying

That was a spleendid joke.

Wherever there are incentives and opportunity, there will be corruptions. It's only a matter of time before buscons emerge.

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