Introduction: Instead of thinking of the developing world as a place where there are desperate people who will sell their kidneys for money, we propose a new approach where the developing world can be seen as a place where there are desperate patients with kidney failure who need kidney transplants and who have willing, living kidney donors, but insufficient financial resources to pay for their transplant and subsequent immunosuppression.

Methods: We propose that the cost differential between dialysis and transplantation in some countries would allow the exchange of kidneys between patient/donor pairs with immunological barriers to transplantation in a First World country with patient/donor pairs with financial barriers to transplantation in a developing world country. By extending first world quality healthcare to impoverished patients in the developing world, we reverse the practice of transplant tourism and shed light and transparency on the black market organ trade by acknowledging that a kidney has financial value, while simultaneously protecting the fact that exchanging a kidney for a kidney transplantation for a desired patient is an altruistic gift and not a commercial exchange.

Results: A blood type (BT) O donor and a BT A, PRA 0% ESRD patient from the Philippines were unable to pay for dialysis or transplantation. A US non-profit paid for their evaluation and some dialysis in the Philippines. A NEAD chain was identified starting with a US BT A non-directed donor (NDD) with no match in the US KPD pool. The US NDD donated to the Filipino recipient, resulting in a BT O Filipino donor who simultaneously donated to continue the chain. To date the chain has resulted in eleven kidney transplants and an active bridge donor. Six recipients had Medicare and five 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. The savings from transplanting 10 U.S. patients compared with the cost of dialysis will exceed $3M over the next 5 years.

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, Reece L, Roth A, Kuhr C, Ekwenna O, Fumo D, Krawiec K, Jain S, Marsh C, Tan M, Paloyo S. Global Kidney Exchange. Am J Transplant. 2016;16 (suppl 3).

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