Global Kidney Exchange: Overcoming the Barrier of Poverty



This month's installment of “The AJT Report” debates the benefits, ethics and sustainability of Global Kidney Exchange. We also look at efforts to shore kidney paired donation implementation in the United States.

The transplant community debates the benefits of Global Kidney Exchange
Key Points:

  • Dialysis is unaffordable for most low‐income individuals around the world.
  • A newly created GKE would enable poor people from developing countries to donate and receive organs.
  • Some stakeholders believe that a widespread GKE would be a sustainable strategy for overcoming financial barriers to transplantation, while others believe that it is misguided or even unethical.
“Transplantation is about giving the gift of life to very sick patients. Global Kidney Exchange (GKE) takes this a step further, by allowing transplant surgeons to give the gift of life to people around the world who are not only very sick and dying, but also too poor to afford the treatment necessary to live with damaged kidneys,” asserts Michael Rees, MD, PhD, professor of pathology at the University of Toledo in Ohio. As one of the founders of kidney exchange (KE), Dr. Rees partnered with economists, law professors and trusted international colleagues to create the GKE as a means for poor people from developing countries to donate and receive organs. “For most people in the world, poverty is the biggest barrier to transplantation,” he points out. “Global Kidney Exchange provides a sustainable strategy to help some of these patients overcome their financial barrier to a life‐saving transplant.”

In a recently published paper, Dr. Rees and his colleagues stressed the financial inaccessibility of dialysis for most low‐income individuals.1 With the GKE, recipients from developing countries not only receive a kidney, but also financial support to help them pay for the medical costs of maintaining their organ after they return to their home country. “Because the GKE involves exchange, it benefits both the foreign pairs and the domestic pairs. It's a win for patients and the donors who love them in both countries,” says Alvin Roth, PhD, professor of economics at Stanford University in Palo Alto, California, and co‐developer of the GKE.
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