A new approach to kidney transplantation developed by a University of Toledo Health transplant surgeon aims to connect donors and patients around the globe in a way that reduces cost, improves quality, and increases access to life-saving care for people suffering from kidney failure.Dr. Michael Rees created the concept of Reverse Transplant Tourism as an alternative to the black market of organ trading, known as transplant tourism.
“This revolutionary concept could be an important step in solving the kidney shortage in the United States,” he said. “To some extent, it also will reduce American participation in the exploitive and dangerous international kidney black market as thousands of more kidneys could become available.”
Instead of thinking of the developing world as a place where there are desperate people who will sell their kidneys for money, Rees proposes 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.The first Reverse Transplant Tourism exchange earlier this year successfully connected Jose Mamaril of the Philippines, who has end-stage renal disease but not the means to pay for a transplant or regular dialysis, with an American donor. His wife, Kristine, donated her kidney as part of the exchange that created a donor chain that has already benefited 10 people with kidney failure and promises to help more with another donor waiting to continue the chain.
These patients have benefited from the help of transplant surgeons at The University of Toledo Medical Center, University of Minnesota Medical Center in Minneapolis, Virginia Mason Medical Center in Seattle, Piedmont Hospital in Atlanta, Wake Forrest University in Salem, N.C., and Scripps Green Hospital in La Jolla, Calif.
In the past, barriers to transplantation have been blood type or antibodies. The barrier Rees is working to overcome now is poverty.
The Mamarils would not be considered poor by most standards. They both are college-educated. She is an accountant for Dunkin’ Donuts in the Philippines’ Laguna province where they live, and he operated a taxi business.
But after Jose was diagnosed with kidney failure, the family needed to borrow money and then sell his business, all of their possessions, and their home to pay for expensive dialysis and medications to keep him alive. It was a difficult time for them and their 8-year-old son, John.
“They never gave up on me,” Jose said.
A series of connections between Rees and other transplant surgeons across the world led to Jose coming to the United States as the first Reverse Transplant Tourism beneficiary. He received his new kidney Jan. 22 at UTMC.
“It’s like a miracle it all happened,” Kristine said.
“I’m happy to get this chance at life and to be here for my son,” Jose said.
In some areas of the world, such as where the Mamarils live, there is little problem finding living kidney donors from family or community members, but they cannot afford dialysis or kidney transplantation.
In the United States, the barrier is more supply and demand. In 2014, nearly 5,000 Americans unnecessarily died waiting for a kidney, and there are currently more than 100,000 patients listed on the UNOS deceased donor waiting list. In 2008, that number was at 84,000. In 2013, there were 16,895 kidney transplants in the United States, only slightly more than the 16,521 performed in 2008. Based on these figures, the kidney transplant waiting list has increased by 34 percent since 2008, yet the number of kidney transplants remains virtually unchanged.
But there are enough donor and recipient pairs in developing countries that would allow many Americans who have incompatible donors to receive a kidney through paired exchanges, Rees said. This is especially true if the donor from the emerging nation has blood type O and the recipient falls within the blood groups of A, B or AB, such as the Mamaril family, he added.
Averaged over time, the cost of treating patients with end-stage renal disease with dialysis is three times the cost of treating patients with kidney transplantation. According to Rees’ research, the annual cost of dialysis for a Medicare patient is $90,000 compared to $33,000 for kidney transplantation. Overall, the United States spends some $50 billion treating end-stage renal disease.
The first Reverse Transplant Tourism exchange was funded with $150,000 raised by the Alliance for Paired Donation, which Rees founded. Philanthropy alone cannot support this method, and it has not yet been financially supported by Medicare and health-care insurers under current policies.
Rees argues that by covering the procedure for one donor and recipient from an emerging nation, not only would Medicare help save American lives but also millions of dollars in medical costs over time.
“As the U.S. looks for unique methods to address health-care reform, Reverse Transplant Tourism is one of very few strategies that simultaneously achieves the goals of reduced cost, improved quality and increased access,” Rees said. “In this new approach, everyone wins.”