Philosophers make case for global kidney exchange program

The GKE reduces the potential for people in poor countries in need of kidneys to be exploited and promotes global justice according to authors of a new paper in The Lancet.

Three bioethicists have today published an argument in The Lancet, one of the world’s leading medical journals, in favour of a global kidney exchange (GKE) program that matches donors and recipients across low and middle-income countries with pairs in high income countries.

Renowned philosopher at the University of Melbourne and Princeton University, Professor Peter Singer, co-authored the paper along with University of Oxford’s Professor Julian Savulescu, Distinguished Visiting Professor in Law at the University of Melbourne and Murdoch Children’s Research Institute and Francesca Minerva, a postdoctoral fellow at the University of Ghent.

The three argue that, far from representing a form of organ trafficking, as some critics have suggested, a global kidney exchange program would reduce suffering and save the lives of rich and poor patients alike.

The program works by matching donor-recipient pairs across high, medium and low-income countries. This means that a recipient in a high income country (HIC) who is unable to find a matching donor in their own country, but has a willing donor such as a partner with a different blood type, could exchange a kidney and at the same time, make it possible for a pair from a low or middle-income country (LMIC) to receive a transplant and the necessary post-operative care that they otherwise could not afford.

This exchange of organs and the provision of life-saving medical treatment benefits all, with the HIC able to save money on the health costs associated with dialysis and the LMIC patient able to receive a life-saving kidney donation.

Broadly speaking, US insurers save about $US 200,000 every time an American patient on dialysis receives a kidney transplant. And each GKE results in the transplant of about two Americans through paired donation chains. So each GKE results in savings for US insurers of about $400,000. Therefore, insurers could pay as much as $200,000 to transplant a foreign recipient through GKE, and still wind up with a net gain of $200,000.

“Far from exploiting the background injustice of ongoing poverty, a system like GKE eliminates the injustice of the lack of access to medical care for kidney patients in LMICs, making it an eminently fair solution,” said Professor Singer.

Co-author Professor Savulescu said: “This system not only matches people by biological compatibility but also by financial compatibility. This is very different to exploitative paid organ donation. It is rare there are so many winners. There is at least one person in a rich country who gets a kidney and off dialysis. There is a poor person who gets a kidney and avoids death. And the taxpayer wins to boot.”

Kidney dialysis is very costly, and a lack of available kidney donations is likely a death sentence for those in low-income countries. The GKE reduces the potential for people in poor countries in need of kidneys to be exploited and promotes global justice.

The paper’s authors hope that a system of global kidney exchange can be implemented and fairly regulated so that individual’s autonomy is upheld, and better health outcomes can be accessed by all regardless of income.

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