A Kidney Exchange Clearinghouse in New England

In 2003 there were 8,665 transplants of deceased donor kidneys for the approximately 60,000 patients waiting for such transplants in the United States. While waiting, 3,436 patients died. There were also 6,464 kidney transplants from living donors (Scientific Registry of Transplant Recipients web site). Live donation is an option for kidneys, since healthy people have two and can remain healthy with one. While it is illegal to buy or sell organs, there have started to be kidney exchanges involving two donor–patient pairs such that each (living) donor cannot give a kidney to the intended recipient because of blood type or immunological incompatibility, but each patient can receive a kidney from the other donor. So far these have been rare: as of December 2004, only five exchanges had been performed in the 14 transplant centers in New England. One reason there have been so few kidney exchanges is that there have not been databases of incompatible patient–donor pairs. Incompatible donors were simply sent home. (Databases are now being assembled not only in New England, but also in Ohio and Baltimore.) Lainie Friedman Ross et al. (1997) discussed the possibility of exchange between incompatible patient–donor pairs. Not only have a few such two-way exchanges been performed, but two three-way exchanges (in which the donor kidney from one pair is transplanted into the patient in a second pair, whose donor kidney goes to a third pair, whose donor kidney goes to the first pair) have been performed at Johns Hopkins. There have also been a number of “list exchanges” in which an incompatible patient– donor pair makes a donation to someone on the waiting list for a cadaver kidney, in return for the patient in the pair receiving high priority for a cadaver kidney when one becomes available.