|
 In particular, a voucher program could help with “chronological
incompatibility,” when the donor wants to provide a kidney but the
patient doesn’t need it yet.
“Innovative solutions to increasing living donation are always
needed because of the high level of need for living donor kidneys,”
said study author Amy Waterman, director of the Transplant Research
and Education Center at the University of California at Los Angeles.
More than 100,000 patients are on the waiting list in the United
States, according to the United Network for Organ Sharing.
“Living donors are rare and very valuable for improving the health
of recipients,” Waterman told Reuters Health by email. “Strategies
to allow more living donors to overcome practical challenges to help
another should be supported.”
In a report in the journal Transplantation, Waterman and colleagues
described three voucher cases that allowed donors to overcome
chronological incompatibility for recipients who didn’t yet need a
kidney but might need one in the future. The three cases also
triggered a donation chain that allowed 25 transplants to occur
across the U.S.
In the first case, a four-year-old with chronic kidney disease was
projected to need a renal transplant in 10 to 15 years. His
64-year-old grandfather wanted to donate a kidney when his grandson
needed it but didn’t want his candidacy as a donor to disappear as
he aged.
The National Kidney Registry Medical Board allowed the grandfather
to donate his kidney now for his grandson to receive priority for
another kidney in the future when he needed it. The board stipulated
that the voucher had no monetary value, could only be used for his
grandson, couldn’t be transferred to another patient, and couldn’t
guarantee that a kidney would be available.
In December 2014, the grandfather donated his kidney, which
triggered a transplant chain with three recipients who were able to
discontinue dialysis. The grandson hasn’t needed the voucher yet.
“This began developing based on requests from patients,” said Stuart
Flechner of the Cleveland Clinic in Ohio, who wasn’t involved with
this study. Flechner studies kidney-paired donations.
“This is a way to capture donors who might otherwise not have
donated if it went through the usual sequencing,” he told Reuters
Health. “It’s based on an individual’s desire to donate now so a
loved one can receive another kidney later.”
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In the second case, a 10-year-old girl underwent a kidney transplant
in 2007. Although it went well, her 52-year-old father wanted to
donate a kidney several years later as a “back-up” in case she
needed it. He wanted to use a voucher to donate the kidney before he
got too old. In 2015, he donated a kidney, which triggered a chain
of eight transplants.
The third case involved the same patient from the second case. Her
doctors believed she might require a third transplant in the future
to avoid dialysis, so the girl’s 60-year-old aunt also donated a
kidney in 2016. The donation initiated a chain of 14 kidney
transplants and provided a second voucher for her niece.
When adopting use of vouchers, transplant centers must consider the
effects of redemptions and guard against the potential for gaming
the system, the study authors say. For example, if recipients don’t
need the transplant or die first from other causes, the voucher
can't be sold or traded.
At the same time, a voucher system could motivate family members to
donate out of altruism now rather than hold back in case their loved
ones need a kidney in the future.
“The more transplants we can arrange, the more people we can help,”
said Blake Ellison of Harvard Law School in Boston, who wasn’t
involved with this study. Ellison has researched kidney-paired
donations and the U.S. model.
“Vouchers remove some of the barriers to donation . . . as a result,
donated kidneys will not only be more plentiful, but healthier,
too,” he told Reuters Health. “Matching systems are such that
increasing the number of kidneys to be matched results in more
matches and better matches.”
SOURCE: http://bit.ly/2oKMoxx Transplantation, online March 22,
2017.
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