April 7, 2017 / 8:11 PM / 3 years ago

Kidney transplant vouchers could address timing issues

(Reuters Health) - - Creating kidney transplant vouchers for future transplants could reduce the long waiting list for organs in the United States, a new study suggests.

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.”

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: bit.ly/2oKMoxx Transplantation, online March 22, 2017.

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