Non‐simultaneous kidney exchange cycles in resource‐restricted countries without non‐directed donation – a prospective single‐center cohort study

Kute, Vivek B.; Patel, Himanshu V.; Modi, Pranjal; Rizvi, Syed Jamal; Shah, PR; Banerjee, Subho; Meshram, Hari Shankar; Butala, Bina P; Modi, Manisha P; Gnadhi, Shruti; Patel, Ansy H; Mishra, Vineet; Roth, Alvin E.; Kopke, Jonathan E.; Rees, Michael

doi:10.1111/tri.13833

Cited by 11 publications

(6 citation statements)

References 33 publications

(62 reference statements)

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“…Nonsimultaneous chains in kidney exchange are another example where economic design relies on people's willingness to cooperate. Selfishness would suggest that people renege on their commitment once their intended donor gets a kidney, but this is a rare event, and market design relies on this to make kidney exchange work at scale (Ashlagi, Gilchrist, Roth, & Rees, 2011;Kute et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

The i-frame and the s-frame: How focusing on individual-level solutions has led behavioral public policy astray

Chater¹,

Loewenstein²

2022

Behav Brain Sci

225

140

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An influential line of thinking in behavioral science, to which the two authors have long subscribed, is that many of society's most pressing problems can be addressed cheaply and effectively at the level of the individual, without modifying the system in which the individual operates. We now believe this was a mistake, along with, we suspect, many colleagues in both the academic and policy communities. Results from such interventions have been disappointingly modest. But more importantly, they have guided many (though by no means all) behavioral scientists to frame policy problems in individual, not systemic, terms: to adopt what we call the “i-frame,” rather than the “s-frame.” The difference may be more consequential than i-frame advocates have realized, by deflecting attention and support away from s-frame policies. Indeed, highlighting the i-frame is a long-established objective of corporate opponents of concerted systemic action such as regulation and taxation. We illustrate our argument briefly for six policy problems, and in depth with the examples of climate change, obesity, retirement savings, and pollution from plastic waste. We argue that the most important way in which behavioral scientists can contributed to public policy is by employing their skills to develop and implement value-creating system-level change.

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Section: Introductionmentioning

confidence: 99%

The i-frame and the s-frame: How focusing on individual-level solutions has led behavioral public policy astray

Chater¹,

Loewenstein²

2022

Behav Brain Sci

225

140

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“…This means that some patients can be transplanted only if long exchange cycles are possible. The recent paper by Kute et al (2021) reports 17 very carefully arranged and conducted non-simultaneous (and non-anonymous) kidney exchange cycles, accomplishing 67 transplants at the Trivedi Institute, with no broken links.…”

Section: How and Whether To Mergementioning

confidence: 99%

Kidney Exchange: An Operations Perspective

Ashlagi

Roth

2021

Management Science

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Many patients in need of a kidney transplant have a willing but incompatible (or poorly matched) living donor. Kidney exchange programs arrange exchanges among such patient-donor pairs, in cycles and chains of exchange, so that each patient receives a compatible kidney. Kidney exchange has become a standard form of transplantation in the United States and a few other countries, in large part because of continued attention to the operational details that arose as obstacles were overcome and new obstacles became relevant. We review some of the key operational issues in the design of successful kidney exchange programs. Kidney exchange has yet to reach its full potential, and the paper further describes some open questions that we hope will continue to attract attention from researchers interested in the operational aspects of dynamic exchange. This paper was accepted by David Simchi Levi, Special Section of Management Science: 65th Anniversary.

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“…Nevertheless, ABOiKT is relevant in India because State/National kidney exchange program has not been initiated broadly, with only a few centers in India offering this approach. 7 However, the literature on ABOiKT protocols and outcomes is ambiguous. [8][9][10][11][12] A recent meta-analysis linked higher graft loss and patient death within 3 y of ABOiKT to ABO-compatible kidney transplants (ABOcKT).…”

Section: Introductionmentioning

confidence: 99%

A Multicenter Retrospective Cohort Study on Management Protocols and Clinical Outcomes After ABO-incompatible Kidney Transplantation in India

Kute,

Pathak,

Ray

et al. 2023

Transplantation

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Background. There is no robust evidence–based data for ABO-incompatible kidney transplantation (ABOiKT) from emerging countries. Methods. Data from 1759 living donor ABOiKT and 33 157 ABO-compatible kidney transplantations (ABOcKT) performed in India between March 5, 2011, and July 2, 2022, were included in this retrospective, multicenter (n = 25) study. The primary outcomes included management protocols, mortality, graft loss, and biopsy-proven acute rejection (BPAR). Results. Protocol included rituximab 100 (232 [13.18%]), 200 (877 [49.85%]), and 500 mg (569 [32.34%]); immunoadsorption (IA) (145 [8.24%]), IVIG (663 [37.69%]), and no induction 200 (11.37%). Mortality, graft loss, and BPAR were reported in 167 (9.49%), 136 (7.73%), and 228 (12.96%) patients, respectively, over a median follow-up of 36.3 mo. In cox proportional hazard model, mortality was higher with IA (hazard ratio [HR]: 2.53 [1.62–3.97]; P < 0.001), BPAR (HR: 1.83 [1.25–2.69]; P = 0.0020), and graft loss (HR: 1.66 [1.05–2.64]; P = 0.0310); improved graft survival was associated with IVIG (HR: 0.44 [0.26–0.72]; P = 0.0010); higher BPAR was reported with conventional tube method (HR: 3.22 [1.9–5.46]; P < 0.0001) and IA use (HR: 2 [1.37–2.92]; P < 0.0001), whereas lower BPAR was reported in the prepandemic era (HR: 0.61 [0.43–0.88]; P = 0.008). Primary outcomes were not associated with rituximab dosing or high preconditioning/presurgery anti-A/anti-B titers. Incidence of overall infection 306 (17.39%), cytomegalovirus 66 (3.75%), and BK virus polyoma virus 20 (1.13%) was low. In unmatched univariate analysis, the outcomes between ABOiKT and ABOcKT were comparable. Conclusions. Our largest multicenter study on ABOiKT provides insights into various protocols and management strategies with results comparable to those of ABOcKT.

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Non‐simultaneous kidney exchange cycles in resource‐restricted countries without non‐directed donation – a prospective single‐center cohort study

Cited by 11 publications

References 33 publications

The i-frame and the s-frame: How focusing on individual-level solutions has led behavioral public policy astray

The i-frame and the s-frame: How focusing on individual-level solutions has led behavioral public policy astray

Kidney Exchange: An Operations Perspective

A Multicenter Retrospective Cohort Study on Management Protocols and Clinical Outcomes After ABO-incompatible Kidney Transplantation in India

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