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Hello. This is Jeffrey Berns of the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. I am Editor-in-Chief of Medscape Nephrology. During this holiday season, when everybody is buying and selling, it is interesting to think about a recent "opposite the editorial" (op-ed) that was in The New York Times, by a young man named Alexander Berger, 21 years old, who was planning to do an altruistic kidney donation. He talks about his decision to do it but also discusses the buying and selling of kidneys for transplant in the United States. He proposes, as has been proposed by others, that perhaps the federal government or some other agency, rather than individuals, could buy kidneys and oversee their equitable distribution to reduce the transplant waiting list and reduce the need for dialysis in the United States.
It is an interesting concept and one that has been discussed many times. It raises all sorts of ethical issues, of course, and I am certainly not an expert in this area, but it is thought-provoking. He mentions in his op-ed piece something called the National Kidney Registry, which, frankly, I was not aware of. You can Google it and find the Website very easily. They are in the business of matching potential donors and potential recipients. It is used by people who have a donor mismatch, people who are looking for a better match, or by people who just want to donate a kidney. They claim on their Website that the waiting time for what they refer to as a "facilitated" -- or "paired" -- exchange is on the order of about 8 months. This is a tiny fraction of the usual wait time for transplants. On this Website is a list of centers around the country that have participated in facilitating these paired exchanges. I was interested to learn that 6 of these had been done at my own institution. They report on the Website that they have done 381 exchanges since February 2008. These are not purchased kidneys; these are altruistic donors and matches for people who have an incompatible donor, and there is an exchange. It does raise the interesting concept of whether there is a way to provide some compensation for donation, as in bone marrow biopsies for bone marrow transplant, and other sources, such as plasma (although that has been done away with for the most part).
Whether kidney donation can be compensated in the United States makes for an interesting discussion. Take a look at the National Kidney Registry Website. Give this some thought.
I hope you all had a nice holiday. This is Jeff Berns from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, and Editor-in-Chief of Medscape Nephrology.
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