kidney chains

From Rhonda Rundle in the WSJ...

The introductory anecdote:

Pamela Heckathorn received a kidney from an anonymous donor on July 30. The operation not only allowed the 51-year-old to avoid dialysis treatments; it also kicked off a chain of transplants that have benefited a number of other kidney patients.

Ms. Heckathorn, a public-school employee in Cypress, Calif., had originally planned to accept a kidney offered by a cousin, but the two had turned out not to be biologically compatible. Before Ms. Heckathorn's surgery, the cousin donated his kidney anyway to another patient. That patient, in turn, also had a willing donor who was incompatible. So that donor's kidney was handed off to yet another patient.

The general principle:

Patients in need of a kidney transplant are seeing a surge in donors as loved ones offer their own kidneys into a pool in the hopes that a "daisy chain" of generosity will save lives.

Kidney chains are an extension of kidney swaps, a practice that has led to hundreds of additional live organ transplants in recent years. A swap occurs between two or more sets of incompatible recipients and donors, who are usually family members. If a donor's organ isn't compatible with a loved one who needs a kidney, doctors are able to swap that organ with one from another incompatible pair. Swap operations are usually performed simultaneously at the same transplant center to avoid a situation where one of the donors backs out at the last moment.

Transplant chains have the potential to help many more kidney patients than swaps, medical experts say. A chain starts with an altruistic individual who wants to donate a kidney to help a stranger in need. The anonymous donation goes to a recipient who has lined up a living donor, but who isn't biologically compatible. In turn, that donor's kidney can benefit other patients who have also lined up living donors who ended up being incompatible, each time passing an extra kidney down the line....

In theory, a chain could continue indefinitely, broken only by an event such as a donor backing out. Surgeons say that so far they aren't aware of any case of that happening....

The overarching problem (caused by a combination of the ban on compensating those who part with their kidneys-- even in death-- and an insufficient number of people who are willing to be altruistic):

Currently there are nearly 77,000 Americans waiting for a kidney transplant. Many of these people could be on the UNOS list for years until an organ donation from a deceased person comes in. Last year, kidney donations in the U.S., from both deceased and living donors, totaled only about 17,000, according to UNOS.

Despite the shortage, many hospitals in recent years have been reluctant to consider offers of kidneys from altruistic donors. Among the concerns: Such donors can require extensive screening for medical and mental-health issues, and they are more likely to back out than are living donor relatives of kidney patients. Last year, there were 97 donations of kidneys in the U.S. by anonymous donors for altruistic reasons....