Vouchers for Future Kidney Transplants May Increase Living Donations Now

By Linda Carroll

June 24, 2021

(Reuters Health) - A program that offers vouchers for future kidneys in exchange for donations in the present may increase the number of living donations and shorten wait times for those who receive the vouchers, a U.S. study suggests.

An analysis of seven years of data from the National Kidney Registry revealed an increase in the number of family voucher kidney donations and a three-month drop in transplant wait times, according to the report published in JAMA Surgery.

"The voucher-based kidney donation program has really taken off," said the study's lead author, Dr. Jeffrey Veale, professor of urology at the David Geffen School of Medicine at the University of California, Los Angeles; director of the UCLA Kidney Exchange Program; and a transplant surgeon at Ronald Reagan UCLA Medical Center.

"It's a great way for grandparents to donate and is almost like leaving an inheritance if they have a grandchild that has kidney disease and maybe doesn't need dialysis or a transplant yet but in 10 or 15 years might," Dr. Veale said. "The grandparent can donate a kidney now and start a chain and then their grandchild can have a voucher that they can redeem in the future if they need it. It's the ultimate invaluable inheritance."

It's also a way to help a relative who currently has a functioning kidney transplant, Dr. Veale said. "The voucher chain is a great opportunity for people who have a functioning transplant now, but they know that the shelf life of the transplant might be only 15 or 20 years," he added. "But by that time their second donor might be too old to donate or because of life-changing events might not be able to donate in 15 or 20 years when the first transplant burns out."

The way the program works, Dr. Veale and his colleagues write, is "the nondirected (i.e., altruistic) kidney donor is able to identify a recipient, who then obtains a voucher that may be redeemed at a later date if a kidney is needed. When a voucher is redeemed, a living donation chain is used to return a kidney to the voucher holder."

Although vouchers provide priority status for a living donor transplant if a kidney is needed, there is no guarantee that a kidney will be available at that time, the researchers note.

To take a closer look at how the voucher program has been working, Dr. Veale and his colleagues turned to the National Kidney Registry (NKR) database, focusing on 79 U.S. transplant centers and voucher-based donations between January 1, 2014 - when the voucher system was implemented - and January 31, 2021.

During the seven years examined, 250 family voucher-based donations occurred. Each donation led to a transplant chain with a mean length of 2.3 downstream kidney transplants, facilitating 573 total transplants. Of those 111 (19.4%) were performed in highly sensitized recipients.

Just 25 donations had occurred by the first quarter of 2018, the study found. But then the numbers began a steady rise that accelerated in 2019 and 2020.

Over the seven-year period, the waiting time for those in the NKR exchange pool decreased by more than three months. Six vouchers were redeemed, all of which led to timely transplants, the authors note. The time from voucher redemption to kidney transplant ranged from 36 to 155 days.

"The voucher program is an excellent idea," said Dianne LaPointe Rudow, director of The Zweig Family Center for Living Donation at Mount Sinai in New York City. "I'm cautiously optimistic about it although the new report looks at just seven years of outcomes."

"The idea is novel and it gives two types of people some help: people who might have a grandchild or child who might need a kidney in the future and they want to donate before they get too old and also people who might think about donating to a stranger but are hesitant because one of their kids might need a transplant one day," Rudow said

The program can work so long as there is proper informed consent that, among other things, lets the donor know that the voucher holder may not be able to use the kidney when the time comes, Rudow said. For example, if the voucher holder develops a potentially fatal disease such as ovarian cancer, they may not be able to use it to get a transplant.

Still, Rudow said, "this program might make people who always thought about donating a kidney more comfortable, which is why I say I am cautiously optimistic. I don't think that many people have heard about it yet."

At Mount Sinai, "we did three in the last three months," Rudow said. "These non-directed donors wanted to help somebody but wanted to make vouchers for family members with the donation."

SOURCE: https://bit.ly/35LXIwH JAMA Surgery, online June 23, 2021.

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