A liver for a kidney: Ethics of trans-organ paired exchange

Abstract

Living donation provides important access to organ transplantation, which is the optimal therapy for patients with end-stage liver or kidney failure. Paired exchanges have facilitated thousands of kidney transplants and enable transplantation when the donor and recipient are incompatible. However, frequently willing and otherwise healthy donors have contraindications to the donation of the organ that their recipient needs. Trans-organ paired exchanges would enable a donor associated with a kidney recipient to donate a lobe of liver and a donor associated with a liver recipient to donate a kidney. This article explores some of the ethical concerns that trans-organ exchange might encounter including unbalanced donor risks, the validity of informed consent, and effects on deceased organ donation.

Marketplaces, Markets, and Market Design

“…It would also be useful to increase the supply of deceased donors. Other avenues that might possibly increase the scope of exchange involve including other organs in exchanges (see Dickerson and Sandholm 2017;Sönmez and Ünver 2017;Samstein et al 2018).…”

Efficient and Incentive‐Compatible Liver Exchange

“…These include Hwang et al (2010) and Chan, Lo, Yong, Tsui, Ng, and Fan (2010), both of which demonstrated the proof of concept for liver exchange, and Mishra et al (2018), which advocated for organized liver exchange in the Unites States. Dickerson and Sandholm (2014) advocated for trans-organ exchange, where a donor associated with a kidney recipient donates a liver lobe and a donor associated with a liver recipient donates a kidney, whereas Samstein, de Melo-Martin, Kapur, Ratner, and Emond (2018) explored some of the ethical concerns this practice might encounter, including unbalanced donor risks. Ergin, Sönmez, and Ünver (2017) studied dual-donor organ exchange, where each patient receives organs from two living donors.…”

Evolving swaps in transplantation: global exchange, vouchers, liver, and trans-organ paired exchange

“…mild reduction in glomerular filtration rate, a single kidney, a family history of kidney disease, complex anatomy, or history of kidney stones) but may still be an appropriate liver donor. This pair may match with another donor/recipient pair that needs a liver (Figure 2,(34))*. Liver donors with aberrant anatomy or insufficient hepatic mass may be appropriate kidney donors.…”