Introduction: Innovative solutions are required to overcome the organ shortage.

Methods: The cost differential between dialysis and transplantation in some countries allows the exchange of kidneys between patient/donor pairs with immunological barriers to transplantation in a developed-world country with patient/donor pairs with financial barriers to transplantation in a developing-world country.

Results: Three international pairs with blood type (BT) O donors and BT A ESRD patients (two pairs from the Philippines and one from Mexico) were unable to pay for dialysis or transplantation in their countries of origin. A US non-profit paid for their evaluation and, if required, paid for dialysis locally prior to travel to the US. Two BT A bridge donors and one BT A non-directed donor (NDD) with no match in a US KPD pool donated their kidneys to the recipient of these international pairs producing a BT O international donor to continue the Global Kidney Exchange (GKE) chain. The first GKE chain ended with a donation to a US waitlist candidate and twelve kidney transplants were produced. Six US recipients had Medicare and five US recipients had commercial insurance. The transplant cost (including NDD nephrectomy and donor complication insurance) for the Filipino recipient was paid for by a non-profit organization. An additional $50,000 was reserved for subsequent immunosuppression and donor/recipient follow-up in the Philippines. After two years the Filipino donor and recipient have excellent renal function. The savings from transplanting 11 U.S. patients compared with the cost of dialysis will exceed $3M over the next 5 years. The two additional GKE chains have thus far produced a total of 11 transplants and both have bridge donors scheduled to continue each chain.

Conclusion: Global kidney exchange provides a unique solution to the lack of available donor kidneys.

CITATION INFORMATION: Rees M, Dunn T, Rees S, Rogers J, Roth A, Kuhr C, Ekwenna O, Krawiec K, Jain S, Marsh C, Sindhwani P, Zimmerman M, Forbes R, Tan M, Ashlagi I, Correa-Rotter R, Paloyo S. Global Kidney Exchange. Am J Transplant. 2017;17 (suppl 3).

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