Bartering for a Compatible Kidney Using Your Incompatible, Live Kidney Donor: Legal and Ethical Issues Related to Kidney Chains

Abstract

Kidney chains are a recent and novel method of increasing the number of available kidneys for transplantation and have the potential to save thousands of lives. However, because they are novel, kidney chains do not fit neatly within existing legal and ethical frameworks raising potential barriers to their full implementation.

Kidney chains are an extension of paired kidney donation, which began in the United States in the year 2000. Paired kidney donations allow kidney patients with willing, but incompatible donors, to swap donors in order to increase the number of donor/recipient pairs and consequently the number of transplants. More recently, transplant centers have been using non-simultaneous, extended, altruistic donor (NEAD) kidney chains -- which consist of a sequence of donations by incompatible donors -- to further expand the number of donations. NEAD chains differ from paired donation because they do not require reciprocal matching or simultaneous transplants. These characteristics arguably create more danger of coercion than traditional donation and also arguably result in kidney chains violating the National Organ Transplant Act (NOTA), which prohibits the transfer of organs for valuable consideration. The Act explicitly exempts paired kidney donations, but because NEAD chains are non-simultaneous and non-reciprocal, they fail to meet the criteria necessary to qualify for this exemption.

This article fully explains kidney chains and also demonstrates that, if safeguards are implemented, NEAD chains are not more coercive than direct donation to a family member. The article also shows that the legislative history of NOTA, its purpose, and the characteristics of NEAD chains all support the legality of NEAD chains under NOTA and the full implementation of this life-saving innovation.