Ethics of a Paired-Kidney-Exchange Program

Domino paired kidney donation: a strategy to make best use of live non-directed donation

“…A donor and recipient who have incompatible blood groups or HLA sensitivity can be matched with another incompatible pair, to result in two compatible transplants (fi gure). [13][14][15][16][17][18][19] Although there are many ways to match up a pool of incompatible pairs, the mathematical technique of optimisation helps to fi nd out which matches will yield the best results. 13 Nevertheless, even in paired-donation programmes in which mathematical optimisation is applied, more than 50% of the incompatible pairs in the pool remain unmatched.…”

Equipoise: Ethical, Scientific, and Clinical Trial Design Considerations for Compatible Pair Participation in Kidney Exchange Programs

“…Exploitation of compatible pairs by media stories focused on their participation should be avoided so as to assure appropriate motivation. Privacy and confidentiality should be assured for CPP as originally described in general for KE participants (8) and for nondirected donors (22).…”

“…Ethical concerns in KE as first proposed by Ross and Woodle outlined included informed consent, privacy and confidentiality, commercialization, and exploitation (8). As additional KE variations emerged that required ethical consideration, Ross and Woodle introduced the concept of CPP in unbalanced kidney exchanges (14), which has been supported by others (12,15).…”

“…One approach for addressing this issue is to assure that neither the donor nor recipient in a compatible pair are aware of details regarding the number of potential pairs in the KE until after the KE is completed. Other standard ethical protections as previously described (8,22) should be followed to protect donor/ recipient pairs in CPP.…”

“…After the initial description of the ethical and scientific principles for kidney exchange (8), the field has progressively expanded, with several nationally based kidney exchange programs established over the past several years, including the Dutch, Australian, Canadian, and British programs (9)(10)(11). A single US kidney exchange program, the National Kidney Registry, facilitated over 300 KE transplants in 2013.…”