The Miracle of Chained Kidney Transplants

Most modern markets operate on money. I sell my services as an economist, for example, and use the proceeds to buy Tazo Tea, vacation trips, and a surprising number of Apple products.

But that approach doesn’t transplant well (so to speak) to living human organs. Many people find the idea of markets in organs repugnant. As a result, money-based organ markets are generally outlawed.

As economists often point out, that moral stance comes with a major cost: many people who need a new kidney can’t find one. Humans have two kidneys, but can live healthy lives with just one. So there is the potential for gains from trade between those who need a kidney and those who have one to spare. The challenge is getting enough people to donate kidneys, when it isn’t possible to compensate them with money.

Some good samaritans do donate kidneys to strangers. But that’s very rare. Far more common are people who will donate a kidney to a relative or friend. But those offers often run into a harsh biological reality. Just because you want to give someone a kidney doesn’t mean it will be a biological match.

Enter the kidney exchange. Simple case: Alice may want to donate to Bob but not be a match. Chuck may want to donate to Daphne but not be a match. But if Alice is a match to Daphne, and Chuck is a match to Bob, then can make an exchange. Alice donates to Daphne, Chuck donates to Bob, and everyone is happy. The miracle of a good match in the kidney barter market.

The trick is finding those matches and extending them to larger groups. Today’s New York Times has a moving article that illustrates how far this idea has come. Kevin Sack recounts how the 60 people shown above were linked through a chain of 30 kidney transplants thanks to the efforts of Garet Hil and the National Kidney Registry. The first donor,Rick Ruzzamenti (upper left), is a good samaritan who felt inspired to give a kidney to a stranger. The other 29 donors all donated on behalf of a friend or relative.

What made the domino chain of 60 operations possible was the willingness of a Good Samaritan, Mr. Ruzzamenti, to give the initial kidney, expecting nothing in return. Its momentum was then fueled by a mix of selflessness and self-interest among donors who gave a kidney to a stranger after learning they could not donate to a loved one because of incompatible blood types or antibodies. Their loved ones, in turn, were offered compatible kidneys as part of the exchange.

Chain 124, as it was labeled by the nonprofit National Kidney Registry, required lockstep coordination over four months among 17 hospitals in 11 states. It was born of innovations in computer matching, surgical technique and organ shipping, as well as the determination of a Long Island businessman named Garet Hil, who was inspired by his own daughter’s illness to supercharge the notion of “paying it forward.”

Dr. Robert A. Montgomery, a pioneering transplant surgeon at Johns Hopkins Hospital, which was not involved in the chain, called it a “momentous feat” that demonstrated the potential for kidney exchanges to transform the field. “We are realizing the dream of extending the miracle of transplantation to thousands of additional patients each year,” he said.

The entire article is inspiring.