Kidney Exchange to Overcome Financial Barriers to Kidney Transplantation

M. A. Rees, T. B. Dunn, C. S. Kuhr, C. L. Marsh, J. Rogers, S. E. Rees, A. Cicero, L. J. Reece, A. E. Roth, O. Ekwenna, D. E. Fumo, K. D. Krawiec, J. E. Kopke, S. Jain, M. Tan, S. R. Paloyo

Research output: Contribution to journalArticlepeer-review

49 Scopus citations


Organ shortage is the major limitation to kidney transplantation in the developed world. Conversely, millions of patients in the developing world with end-stage renal disease die because they cannot afford renal replacement therapy—even when willing living kidney donors exist. This juxtaposition between countries with funds but no available kidneys and those with available kidneys but no funds prompts us to propose an exchange program using each nation’s unique assets. Our proposal leverages the cost savings achieved through earlier transplantation over dialysis to fund the cost of kidney exchange between developed-world patient–donor pairs with immunological barriers and developing-world patient–donor pairs with financial barriers. By making developed-world health care available to impoverished patients in the developing world, we replace unethical transplant tourism with global kidney exchange—a modality equally benefitting rich and poor. We report the 1-year experience of an initial Filipino pair, whose recipient was transplanted in the United states with an American donor’s kidney at no cost to him. The Filipino donor donated to an American in the United States through a kidney exchange chain. Follow-up care and medications in the Philippines were supported by funds from the United States. We show that the logistical obstacles in this approach, although considerable, are surmountable.

Original languageEnglish (US)
Pages (from-to)782-790
Number of pages9
JournalAmerican Journal of Transplantation
Issue number3
StatePublished - Mar 1 2017

Bibliographical note

Funding Information:
Michael Rees, David Fumo, Susan Rees, and Laurie Reece were supported in part by Agency for Healthcare Research and Quality grant R18 HS-020610. Alvin Roth is supported in part by National Science Foundation grant 1061932. The authors thank the nondirected kidney donor who made this first GKE possible. We thank all the transplant coordinators whose tireless efforts make kidney exchange possible, especially Amy Miller, Jennifer Holloway, Barbara O’Neal, Megan Parker, Leanne Whitehead, and Margaret Voges, who helped coordinate the kidney exchanges involving the couple from the Philippines. We also thank the social worker, Ashley Overton, and independent donor advocate, Jenese Lee, who helped care for the Filipino couple. We thank Richard Paat and Andrew Torres, who, on behalf of the Filipino Association of Toledo, provided housing, food, transportation, and entertainment for the Philippine couple during their stay in Toledo, Ohio. We thank Steven Selman on behalf of the Urology Department of the University of Toledo, the board members of the Alliance for Paired Donation, the University of Toledo, the University of Minnesota, the Virginia Mason Medical Center, and Hylant for underwriting the financial risk had there been a donor complication in the initial nondirected donor. We thank David Morlock, CEO of the University of Toledo, who negotiated a fair price for the first GKE and bore the financial risk of a significant complication involving the Filipino recipient. Finally, we thank Steve and Ann Stranahan, Pat and Robin Stranahan, Dave and Hillary White Jr., Dave White Sr., and an anonymous donor for financially supporting the first GKE.

Publisher Copyright:
© 2016 The American Society of Transplantation and the American Society of Transplant Surgeons


  • clinical research/practice
  • disparities
  • donors and donation: living
  • donors and donation: paired exchange
  • economics
  • ethics
  • ethics and public policy
  • kidney transplantation/nephrology
  • law/legislation
  • organ procurement and allocation


Dive into the research topics of 'Kidney Exchange to Overcome Financial Barriers to Kidney Transplantation'. Together they form a unique fingerprint.

Cite this