Kidney Paired Donation and the “Valuable Consideration” Problem

Abstract

As organ donation rates remain unable to meet the needs of individuals waiting for transplants, it is necessary to identify reasons for this shortage and develop solutions to address it. The introduction of kidney paired donation (KPD) programs represents one such innovation that has become a valuable tool in donation systems around the world. Although KPD has been successful in increasing kidney donation and transplantation, there are lingering questions about its legality. Donation through KPD is done in exchange for-and with the expectation of-a reciprocal kidney donation and transplantation. It is this reciprocity that has caused concern about whether KPD complies with existing law. Organ donation systems around the world are almost universally structured to legally prohibit the commercial exchange of organs. Australia, Canada, and the United States have accomplished this goal by prohibiting the exchange of an organ for "valuable consideration," which is a legal term that has not historically been limited to monetary exchange. Whether or not KPD programs violate this legislative prohibition will depend on the specific legislative provision being considered, and the legal system and case law of the particular jurisdiction in question. This article compares the experiences of Australia, Canada, and the United States in determining the legality of KPD and highlights the need for legal clarity and flexibility as donation and transplantation systems continue to evolve.

Legislation and Policy Recommendations on Organ and Tissue Donation and Transplantation From an International Consensus Forum

“…Consequently, jurisdictions should consider formally establishing agreements that specify the necessary collaboration of clinical teams in all involved countries to ensure proper assessment and followup care of the recipient and, if appropriate, the donor. 2,44,[98][99][100] Exchanging organs across jurisdictional boundaries within a country (eg, from one state or province to another) should be regulated through national data sharing agreements that allow for the exchange of confidential patient information for the use of clinical and quality improvement purposes.…”

Current protocols and outcomes of ABO-incompatible kidney transplantation

“…Several programs exist worldwide. A recent paper from Toews et al[ 90 ] compared the experience of Australia, Canada and the United States, but to date, other countries such as Holland have a well-developed KPD national program.…”

Living organ donation: development trends

“…Пары и цепочки доноров, несмотря на принцип самодостаточности государств в обеспечении донорскими органами, часто выходят за границы стран. Примерами международных соглашений по обмену донорами являются программа почечного пожертвования между СШа, Канадой и австралией [38], обмен донорскими органами между республикой ирландия и Великобританией [39], взаимодействие в вопросах донорства органов между австралией и Новой зеландией [35]. Уже более полувека активно в Европе функционирует система Евротрансплантант, созданная по инициативе профессора Ван руда на базе Лейденского университета (Нидерланды) и отвечающая за распределение донорских органов среди жителей 8 стран с численностью населения более 135 млн человек [40,41].…”