Eight people with kidney failure saved in first use of new transplant method

TOLEDO, OHIO – A new approach to kidney transplantation developed by a Toledo surgeon connects donors and patients across the globe in a way that reduces cost, improves quality and increases access to life saving care for people suffering kidney failure.

Dr. Michael Rees, a transplant surgeon at The University of Toledo Medical Center and founder of the Alliance for Paired Donation, 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,” Dr. Rees 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, Dr. 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 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 will ultimately benefit eight people with kidney failure with 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 and Piedmont Hospital in Atlanta.

Reverse Transplant Tourism addresses the two major problems faced by the U.S. and developing nations. In the U.S., it is a shortage of both deceased and living kidney donors. Within developing nations, the problem is poverty.

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.

In developing countries, people with kidney failure have little problem finding living kidney donors from family or community members. The issue is instead the ability to afford dialysis or kidney transplantation.

Reverse Transplant Tourism resolves the problems by addressing supply and demand as well as health care costs.

There are enough donor and recipient pairs in developing countries that would allow more than one thousand additional Americans who have incompatible donors to receive a kidney through paired exchanges each year. 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.

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 Dr. Rees’ research, the annual cost of dialysis for a Medicare patient is about $90,000 compared to $33,000 for kidney transplantation. Overall, the U.S. spends some $50 billion treating end stage renal disease.

The first Reverse Transplant Tourism exchange was funded with $250,000 raised by the Alliance for Paired Donation. But philanthropy alone cannot support this method and it is not clear if Medicare can financially support the project under current policies. Several private healthcare insurers are considering financial support of the concept.

Dr. Rees argues that by covering the cost of the transplant procedure for recipients from emerging nations, not only would Medicare and other healthcare insurance providers help save American lives but also millions of dollars in medical costs over three to five years.

“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,” Dr. Rees said. “In this new approach, everyone wins.”

Media Coverage
NBC 24 (Feb. 5, 2015)
The Blade (Feb. 8, 2015)

Tags: The University of Toledo Medical Center (UTMC)