Global Kidney Exchange: Analysis and Background Papers from the Perspective of Medical Anthropology

Kidney International, 2005

International aid and medical practice in the less-developed world: Doing it right, what can renal organizations learn? The delivery of health care in poorer countries is reliant on international aid organizations. This article will focus on international aid and medical practice in the developing world. It will review the general issues, practices, and problems with international aid in the medical arena and will then focus on international aid, kidney detection, and prevention programs. The article will analyze some of the existing and successful organizations and their initiatives. The first part of this article will analyze such aspects as: the access of existing resources and available aid projects; the establishment of contact with international aid projects; the access of funds for the development of the project and, once it is established, the management of those funds; the planning of projects; and the role of research in international aid and medical practice both as a means of accessing resources and of managing the project. The second part of the article will look more specifically at issues in nephrology and international aid. The focus will be on current programs in nephrology and the critical appraisal of some existing programs. The last part will focus specifically on practical tasks which are needed when accessing international aid for medical projects. It will draw on the experiences of various programs and then outline suggested phases one should consider when establishing aid projects in order to best implement them. Kidney groups with intentions to deliver prevention and management strategies to developing countries need to learn from the experiences of existing international aid organizations and chronic kidney disease programs.

Hastings Center Report, 2009

American Journal of Nephrology, 2012

European urology focus, 2018

Global Kidney Exchange (GKE) offers an opportunity to expand living renal transplantation internationally to patients without financial means. These international pairs are entered into a US kidney exchange program that provides long-term financial support in an effort to identify opportunities for suitable exchanges for both these international pairs and US citizens. While the promise of GKE is significant, it has been met with ethical criticism since its inception in 2015. This paper aims to demonstrate the selection process and provide >3 yr of follow-up on the first GKE donor and recipient from the Philippines. The first GKE transplant occurred with a young Filipino husband and wife who were immunologically compatible, but lacked the financial means to continue hemodialysis or undergo a kidney transplant in their home country. The pair was enrolled in the Alliance for Paired Donation matching system, several alternative kidney exchanges were identified, and the pair subsequen...

Hong Kong Journal of Nephrology, 2012

Kidney …, 2003

International braz j urol, 2019

To the editor, Kidney transplantation is the treatment of choice for eligible patients who have reached end stage renal disease (ESRD). It significantly improves patient survival and quality of life, and reduces cost of health care when compared to dialysis. Six decades of success in the field of transplantation have made it possible to save thousands of lives every year. However, we have been facing an ever-growing shortage of organs in the recent years. The supply of kidneys available for transplantation has not come close to an ever-increasing demand for transplantation. In the United States there are currently more than 100.000 patients waiting for kidney or kidney-pancreas. However, the supply of kidneys that stagnated around 16.000 to 17.000 per year (10.000-11.000 deceased donor and around 6.000 live donor kidneys per year) in the decade between 2004 and 2014 has since then increased to near 20.000 kidneys in 2017, predominantly secondary to increased availability of deceased donor kidneys from drug overdose deaths (opioids addiction crisis) in the USA (1, 2). There has been a decline in the annual number of living donor kidneys from a peak of 6.648 in 2004 to only 5.813 in 2017. Moreover, while only 20% of the half million dialysis patients in USA make it to transplant wait list, of them 5.000 die each year waiting (an annual mortality rate of around 7% among patients waiting for a kidney) (1). The ever-widening gap between demand and supply has resulted in an illegal black market and unethical transplant tourism of global proportions (3, 4). The global organ crisis has led to transplant tourism and a black market in kidneys that creates dangerously high risks for all involved. Rich patients from the United States,

Transplantation, 2016

Background. Long-term follow-up and management of donors was undertaken in a specialist kidney transplant unit in Pakistan to identify risk and prevent adverse outcomes in living related kidney donors. Methods. In an observation cohort study between 1985 and 2012, 3748 donors were offered free medical follow-up and treatment 6 to 12 months after donation and annually thereafter. Each visit included history, physical examination, blood tests for renal, lipid, glucose profiles, and 24-hour urine for proteinuria and creatinine clearance. Preventive intervention was undertaken for new onset clinical conditions. Donor outcomes were compared with 90 nondonor healthy siblings matched for age, sex, and body mass index. Results. Of the 3748 donors, 2696 (72%) were in regular yearly follow-up for up to 27 years (median, 5.6; interquartile range, 7.9). Eleven (0.4%) died 4 to 22 years after donation with all-cause mortality of 4.0/10 000 person years. Six (0.2%) developed end-stage renal disease 5 to 17 years after donation, (2.7/10 000 person years). Proteinuria greater than 1000 mg/24 hours developed in 28 patients (1%), hypertension in 371 patients (13.7%), and diabetes in 95 patients (3.6%). Therapeutic intervention-controlled protein was less than 1000 mg/24 hours, blood pressure was below 140/90 mm Hg, and glycemic control in 85% up to 15 years after onset. Creatinine clearance fell from 109.8 ± 22.3 mL/min per 1.73 m 2 predonation to 78 ± 17 at 1 year, 84 ± 19 at 5 years, and 70 ± 20 at 25 years. Comparison of 90 nondonor sibling and donor pairs showed significantly higher fasting glucose and hypertension in nondonors. Conclusions. Long-term follow-up of donors has demonstrated end-stage renal disease in 0.6% at 25 years. Regular follow-up identified new onset of disease and allowed interventions that may have prevented adverse outcomes.

Nephron, 2017

Forced migration is on the rise, mainly from the Middle East to western countries, resulting in unprecedented moral, political, and economic challenges for both refugees and host communities. Recent research showed that refugees represent around 1.5% of the dialysis population in several European and Middle Eastern countries surveyed. Despite the fact that refugees represent a small percentage of all dialysis patients in these countries, adequate care for this population is challenging. There are cultural differences between refugee patients with end-stage renal disease hailing from the Middle East, who are predominantly Muslims, and people from the western host countries. These differences may present a major obstacle in ensuring adequate patient care. In this study, we identify several of these issues that we believe western renal providers should be aware of.

Proceedings of the National Academy of Sciences, 2021

Kidney failure is a worldwide scourge, made more lethal by the shortage of transplants. We propose a way to organize kidney exchange chains internationally between middle-income countries with financial barriers to transplantation and high-income countries with many hard to match patients and patient–donor pairs facing lengthy dialysis. The proposal involves chains of exchange that begin in the middle-income country and end in the high-income country. We also propose a way of financing such chains using savings to US health care payers.

Kidney international supplements, 2020

International journal of organ transplantation medicine, 2012

World Kidney Day on March 8th, 2012, provides a chance to reflect on the success of kidney transplantation as a therapy for end-stage kidney disease that surpasses dialysis treatments, both for the quality and quantity of life, that it provides and for its cost effectiveness. Anything that is both cheaper and better, but is not actually the dominant therapy, must have other drawbacks that prevent replacement of all dialysis treatment by transplantation. The barriers to universal transplantation as the therapy for end-stage kidney disease include the economic limitations which, in some countries place transplantation, appropriately, at a lower priority than public health fundamentals such as clean water, sanitation and vaccination. Even in high-income countries the technical challenges of surgery and the consequences of immunosuppression restrict the number of suitable recipients, but the major finite restrictions on kidney transplantation rates are the shortage of donated organs and...

Free markets can create a spirit of community by fostering mutual goodwill and trust. But a lack of community spirit can also prevent free, non-exploitative markets in kidneys from arising or flourishing. So can communities that are hostile to markets, such as the powerful special-interest “International Transplant Community” (ITC). In this paper I (i) examine and reject the arguments against legalizing kidney sales; (ii) explain how even a free, mutually beneficial exchange can be exploitative; (iii) argue that the best hope for non-exploitative markets in poor countries like India is foreign medical investment and global trade in kidneys; and (iv) propose two psychological reasons for the ITC’s continued opposition to kidney markets.

American Journal of Kidney Diseases, 2008

Never doubt that a small group of thoughtful, committed citizens can change the world: Indeed, it's the only thing that ever has." -Margaret Mead M arch 13, 2008, heralds the third annual World Kidney Day (WKD), an event that will be celebrated in more than 60 countries. We take this opportunity to recount how this concept has gained worldwide traction and momentum and to reflect on the challenges faced by its creators and supporters.