Global Kidney Exchange: An International Approach to Expanding Living Donor Kidney Transplantation in Minority Groups
UVA Law Faculty Affiliations
INTRODUCTION AND OBJECTIVES
Continued innovation in allocation strategies is necessary to overcome the global organ shortage and improve inequities to treatment access for disadvantaged groups.
In many countries, the savings generated from successful transplantation versus continued long-term dialysis permits the creation of a kidney paired donation (KPD) chain including a developing country's pairs and pairs from developed countries. The developing country's pair can overcome financial barriers to transplantation while the developed country's pairs overcome immunological barriers. A wider immunological, ethnic, and socioeconomic range of patients is now included in KPD matching algorithms, providing more opportunities for chains and transplants. Thus, Global Kidney Exchange (GKE) utilizes these savings to provide transplantation access for a wider global population as well as providing more opportunities to match highly sensitized potential recipients.
Since 2015, 4 consecutive GKE chains have occurred, generating 27 total transplants. These were initiated by pairs from both the Philippines and Mexico. 3 pairs were blood-type (BT) O donors with BT A recipients, and 1 pair was a BT O donor with a BT O recipient. The number of transplants from each chain is 12, 7, 6, and 2, with 3 Bridge Donors pending. 16 of the recipients were BT O, 8 were BT A, and 3 were BT B. 40.7% (11 in 27) of recipients were non-Caucasian ethnic minorities. Mean donor age was 46.9 (range 26 to 65). Mean recipient age was 52.6 (range of 32 to 72).11 recipients had a PRA of 0-20%, 10 recipients had a PRA of 21-79%, and 6 recipients had a of PRA > 80% at the time of transplant. Currently, the pre-, post-, and intra-operative expenses for international pairs were all funded philanthropically. A total of $200,000 was allocated for post-transplant immunosuppression and post-operative care of the international donors and recipients. At most recent follow-up all patients have excellent renal function.
In addition to providing a mechanism to overcome financial and immunological barriers to kidney transplantation, Global Kidney Exchange has the potential to ameliorate disparities in living donor kidney transplantation in traditionally disadvantaged minority groups.