Kidney Coupons Would Help People Who Need Transplants

Of the nearly 120,000 Americans waiting for an organ, about 100,000 of them need a kidney transplant. Fourteen of those people will die each day, many after spending years on dialysis. Some kidney patients hope to get an organ from a living donor through a complex process known as a "donation chain"—that's where a bunch of donors and potential recipients are grouped together to find biologically compatible pairs and essentially exchange kidneys. Reuters reports that a voucher system could help speed along the donation chain process and save lives.

A recent paper in the journal Transplantation outlined three cases where someone donated a kidney to a stranger in exchange for a voucher that would give their loved one priority for a future kidney transplant. Essentially, it's a kidney coupon that allows people to donate when they're young and healthy and can help jump-start these lifesaving donation chains.

Kidney disease can be identified several decades before stage-five renal failure necessitating a transplant and some genetic causes are apparent at birth, says Amy Waterman, director of the Transplant Research and Education Center at the University of California at Los Angeles and one of the study authors. A parent, grandparent, aunt, or uncle might want to donate a kidney to a child who will eventually need one, but most surgeons and experts discourage people older than 65 from donating. So it's entirely possible that the would-be donor will be too old to help by the time the intended recipient needs a transplant. Because of these "chronologically incompatible" pairs (that's the medical jargon), some transplant centers like UCLA have a voucher system: Donate today and your loved one gets a voucher they can use later.

To assess the benefit of these vouchers, the researchers followed three people who donated in exchange for vouchers: A 64-year-old man who donated for his four-year-old grandson who was projected to need a transplant in his teens; a 52-year-old man who donated for his ten-year-old daughter who'd already had a kidney transplant but might need more in the future; and the 60-year-old aunt of the girl in the second case who wanted to provide her niece with another back-up because she might need it. These three kidneys went into the donation chain system and triggered a total of 25 transplants—three from the first case, eight from the second, and 14 from the third.

Since organs have a pretty short shelf life, all of the transplants in a chain must occur within a few days of one another and one kidney can complete a chain of say, 14, where there are willing donors who are not biologically compatible with the people who need the kidneys.

"The shortage of kidney donors has been a problem for years," Waterman says. "We're trying to create innovative solutions to help living donors help as many people as possible."

Vouchers are a way to kickstart the process, but there are still concerns. "These vouchers are valuable, so we need to make sure they aren't being sold," Waterman says, because that could create a system of de-facto organ trafficking. Donors also need to understand that "the intention will be to help their loved one, but there are no guarantees." The intended recipient could die before they need the transplant, at which point Waterman says the non-transferable voucher should become worthless to prevent resale or any of kind of currency-like status.

Because federal law and a consensus of medical ethics bans monetary reward for organ donations, the only way to increase live donations is to find another way to appeal to people who want to help a loved one with some stage of kidney disease.

"There are good people who can't donate [to their recipient] today," Waterman says. "This is another way to allow them to donate and start to do good in the world."

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