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Medicine Math

Rare 9-way Kidney Swap a Success 130

Posted by Soulskill from the healing-with-math dept.
Okian Warrior sends news that a complex set of 18 surgeries has been successfully completed at California Pacific Medical Center and the University of California at San Francisco Medical Center that resulted in nine donors sending kidneys to recipients in need. This web of kidney swaps arose because many of the people with failing kidneys had donors willing to help them, but weren't a biological match. Rather than give up on the transplant altogether, doctors were able to arrange the willing donors in a way such that each patient who needed a kidney was able to get one. "Software matching programs have been driving the trend. The programs use blood type and other patient data from medical tests to connect people who are compatible."
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Rare 9-way Kidney Swap a Success More

Rare 9-way Kidney Swap a Success

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  • Piss-poor situation (Score:3, Insightful)

    by penguinoid ( 724646 ) on Sunday June 07, 2015 @02:37AM (#49860045) Homepage Journal

    Part of the problem is the big shortage of organs. I'm not sure what to think about this, in that this sort of thing might decrease any purely voluntary no-strings-attached donations. Maybe we should just allow people to buy kidneys, instead of requiring this sort of complex web of conditional donation.

    • Re:Piss-poor situation (Score:4, Insightful)

      by Anonymous Coward on Sunday June 07, 2015 @02:50AM (#49860071)

      Beautiful libertarianism. The life saving organ transplants go to the wealthiest first, it's the free market and it's the fairest way.

      • If kidneys could be bought, insurance companies would be happy to pay quite the price for them (compared to the cost of regular dialysis and additional health problems).

        • If kidneys could be bought ...

          Kidneys CAN be bought. They can also be sold. It is just that the donor (or the donor's family) cannot be compensated. The hospitals make a fortune, because they get something for nothing, and sell it for over $100k. This policy promotes artificial scarcity, which sustains high prices, and keeps the racket going.

          • Re: (Score:2)

            by Bengie ( 1121981 )

            Kidneys CAN be bought. They can also be sold.

            Other than it is illegal to sell an organ in any situation. Even if the hospital gets a "free" organ because someone died and is labeled an organ donor, it is illegal for the hospital to sell that organ. They can be compensated for the cost of transporting the organ in the case another hospital wants it, but no net profit should be made.

            • Wrong

              Look at the procurement column. That is how much it costs to buy the organ and the donor gets $0, but the hospital harvesting it gets that procurement fee.

              If you need a kidney you will pay, on average, $67,200 for the kidney and only the kidney.

            • Re:Piss-poor situation (Score:4, Informative)

              by ShanghaiBill ( 739463 ) on Sunday June 07, 2015 @02:03PM (#49862367)

              Other than it is illegal to sell an organ in any situation.

              You are wrong [transplantliving.org]. In 2011, the average procurement cost for a kidney was $67,200. For a heart, you would pay $80,400. None of that goes to the donor, or the donor's family, except for reimbursement of direct medical expenses. It is a very profitable racket.

      • Re: (Score:1)

        by Tablizer ( 95088 )

        If the poor could easily sell their kidneys for their family's benefit upon death, then the rest could afford them. Pay them up front even for the "rights". This is for those of you who worry about your family whacking you for profit.

        • Most people who die naturally probably don't have very healthy kidneys by the time they die.

          • Nobody is chaining you there. You can move into a cheap apartment and start digging ditches. Even stocking items at Walmart has got to be better for you than sitting at a desk for 9 hours a day.

          • If the organs of most people dying would be available for transplantation, only a small fraction would be needed. A significant minority of people dies with perfectly fine kidneys.
            I once heard about a traumatologist cynically referring to motor cyclists as 'future organ donors', for example.

            • That's why you should always wear those kidney protectors when cycling. These things can turn bad so easily and they're so valuable...

            • "If the organs of most people dying would be available for transplantation, only a small fraction would be needed."

              If we can work out how to grow cloned parts in the lab then we don't have the ethical issues of transplants OR having to worry about keeping people on anti-rejection drugs for the rest of their lives.

              Foreign donor transplantation is a last resort and it leaves the recipient in need of constant medical care for life. We can do it, but it shoul dbe a stepping stone, not an end in itself.

        • Maybe the poor could also raise and sell their children to be food for the wealthy, while they're at it.

      • Re: (Score:3, Insightful)

        by Rich0 ( 548339 )

        Beautiful libertarianism. The life saving organ transplants go to the wealthiest first, it's the free market and it's the fairest way.

        This is zero-sum thinking. Most life saving organ transplants go to the grave right now. If there was a financial incentive to donate, then there would be a LOT more organs to go around. Sure, they would go to the wealthy first as you point out, but there aren't that many wealthy people out there (by definition), so many more will go to the rest of us.

        There isn't any aspect of life where the wealthy don't benefit more than the rest of us. If that were a reason not to do something, then for the most part

        • Re: (Score:3)

          by ecotax ( 303198 )

          This is zero-sum thinking. Most life saving organ transplants go to the grave right now. If there was a financial incentive to donate....

          It's indeed a shame a lot of potential organ transplants go to the grave right now. Reasoning about this primarily in financial terms first makes no sense, though. After all, what am I going to do with the money when I'm dead? Bury it with me? OK, it could give me a good feeling if I knew it would help my relatives. But then it's about helping others, not about money, and this should be the starting point of reasoning about this issue.

          • It's indeed a shame a lot of potential organ transplants go to the grave right now. Reasoning about this primarily in financial terms first makes no sense, though. After all, what am I going to do with the money when I'm dead?

            Better question: what are your wife and kids going to do with the money when you're dead?

            Seriously, I've been telling my wife for years to donate my leftovers to the local medical school. Unfortunately, my cancer history means my leftovers are basically useless for transplanting.

            • Re: (Score:2)

              by ecotax ( 303198 )

              Better question: what are your wife and kids going to do with the money when you're dead?

              Agreed, after there's 'me' left that question makes more sense.

              Seriously, I've been telling my wife for years to donate my leftovers to the local medical school. Unfortunately, my cancer history means my leftovers are basically useless for transplanting. But, given that I were reasonably healthy, I'd feel quite comfortable with her getting the proceeds from whatever leftovers still were useful after I got done using them....

              I understand that, and I would feel the same. But would you consider helping your family financially more important than helping an unknown person fighting for his life? To personally, the second thing would be more important, unless my family would be in a really desperate financial situation.

              • But would you consider helping your family financially more important than helping an unknown person fighting for his life?

                A quick glance at reality shows that nearly everyone would choose to help their relatives over some stranger. An organ market would allow them to do both.

          • Re: (Score:3)

            by Rich0 ( 548339 )

            After all, what am I going to do with the money when I'm dead? Bury it with me? OK, it could give me a good feeling if I knew it would help my relatives. But then it's about helping others, not about money, and this should be the starting point of reasoning about this issue.

            In the one case it is about helping strangers (the likely recipients of your organs), and in the other case it is about helping your family (the likely recipients of the money raised from selling your organs).

            People will do a lot more for their family than strangers.

            Also, in this case we're talking about kidney donations while the donor is still alive. It is very rare to have somebody walk into a hospital and just ask if they can donate a kidney for anybody who happens to need it. However, that is how man

            • Re: (Score:3)

              by ecotax ( 303198 )

              In the one case it is about helping strangers (the likely recipients of your organs), and in the other case it is about helping your family (the likely recipients of the money raised from selling your organs).

              People will do a lot more for their family than strangers.

              Absolutely true, and I understand the way this worked in this case. I was just thinking out loud about solving the problem of donor organ shortage in general. I'm not expecting most people to volunteer being an organ donor while alive - it's simply asking a bit much. But many people could be convinced to potentially become an organ donor after death simply for altruistic reasons. Neither organs nor money aren't going to be of any use to you. Why not help someone else, even if it's a person you don't know?

              • Re: (Score:2)

                by Rich0 ( 548339 )

                I've heard of many reasons that people don't donate.

                One is just laziness. Depending on the jurisdiction explicit consent is required, and that takes some amount of effort. There have been laws passed in many places to eliminate this barrier, such as requiring people to answer yes/no when renewing a driver's license (which thus requires equal effort to accept/decline), or moving to a default-consent model.

                Another I've heard is fear that a doctor will act against their interests if somebody needs the kidney

        • If you cannot see a flaw in the plan to give a monetary incentive to people for the case when one of their relatives dies, I can.

          • Re: (Score:3)

            by Rich0 ( 548339 )

            If you cannot see a flaw in the plan to give a monetary incentive to people for the case when one of their relatives dies, I can.

            Insurance already creates that incentive today. That is why the first people who get investigated when somebody dies are their heirs. I don't really see organ donations changing that.

            However, as with insurance it probably would require making the money from organ sales go straight to a beneficiary and skipping the estate. Otherwise anybody in heavy debt will probably elect to just let their organs rot, since it won't benefit anybody they actually care about.

            • Certainly, the problem is just that in this crime you'll probably have everyone who could raise a red flag involved in the spiel. The relatives get money, the hospital gets organs, society gets rid of a shortage of organs. In the example you describe there is at least an insurance that has an interest in discovering foul play, and the means to.

              I cannot detect anyone like this here, but a lot of parties interested in covering it up.

        • There isn't any aspect of life where the wealthy don't benefit more than the rest of us.

          Although I mostly agree with this statement, this is actually one area where the poor *could* benefit more.
          First off, paying for organs would make more organs available and secondly, 10k is a lot more useful to
          a poor family that just lost someone than it is to a rich family that just lost someone. Obviously there
          needs to be checks (especially on the still living) to make sure it's not abused but most poor people
          don't have life insurance and an extra 10k-100k at death could actually benefit their family gre

          • Obviously there needs to be checks (especially on the still living) to make sure it's not abused but most poor people don't have life insurance and an extra 10k-100k at death could actually benefit their family greatly.

            Yes, it could, and pretty soon it's expected you sell your organs first before seeking public assistance. This is a horrible idea that needs to be snipped in the bud.

            • Re: (Score:2)

              by Rich0 ( 548339 )

              Obviously there needs to be checks (especially on the still living) to make sure it's not abused but most poor people don't have life insurance and an extra 10k-100k at death could actually benefit their family greatly.

              Yes, it could, and pretty soon it's expected you sell your organs first before seeking public assistance. This is a horrible idea that needs to be snipped in the bud.

              Being expected to sell your organs before seeking public assistance certainly is a horrible idea. I'm not convinced that this means that selling your organs is a horrible idea.

              Look, the only body who can require anybody to sell their organs to receive public assistance is the legislature. That happens to be the only body who can also allow people to sell their organs in the first place. So, if you can't trust the legislature to do the right thing, then you're up the creek already.

              I don't think that we sh

      • Self-described libertarians can say some pretty stupid stuff sometimes, but this isn't one of them. If person to person monetary incentives are allowed (within certain guidelines), then there are more kidneys available period. Structured the right away, this could easily mean more kidneys and shorter waiting lists for poor people as well.

        • More kidneys will be available, right. The question that remains, though, is whether all donors didn't need them anymore...

          • A laughably worthless statement. Legalizing compensation for kidney donation in no way implies that someone who walks into a hospital with a bloody baggie refusing to tell them where the kidney came from must be served. The transplant team would obviously be working on both patients and do an assessment beforehand. This isn't Tor for kidneys; this is just compensation.

            If the black market for kidneys really does exist (isn't an urban legend), then increasing the supply of legal kidneys can only shrink the

            • If the enterprising organ harvester is the only foul play you could think of, you're not looking hard enough. Allow me to elaborate?

              I'd guess the main culprits of this crime would actually work in hospitals. Especially in areas that serve poor people, simply because they are the least likely to defend against it. During the operation we had to remove a kidney, sorry, but thanks that you signed that form that indemnifies us. And your uncle Jack, he won't make it, he's already pretty much brain dead, let's pu

              • I'm pretty sure these objections are pretty easy to defend against. No compensation for dead or comatose donors, for instance. Ideally you would allow a way around this with a detailed written directive, but if you're so positive that this could be abused then it can be disallowed--there are billions of healthy, mentally sound people walking around with a spare. With a properly regulated incentive system and public education about the relative safety of kidney donation, it seems pretty clear that everyone
    • Part of the problem is rampant diabetes and obesity, which ultimately leads to kidney disease in many situations.

    • Or you can do it like Austria.

    • Re: (Score:1)

      by jfern ( 115937 )

      In a few years, stem cells may allow for organs to be simply grown, making the whole situation much better.

      • Is that the same few years that cold fusion is away? I keep hearing that nearly as long as I get to hear the "10 years to cold fusion".

    • Re: (Score:2)

      by GNious ( 953874 )

      Up next, remove all taxes on motorcycles, give away drivers-licenses and make organ-donation mandatory? That would solve the shortage-problem preeeetty quickly.

    • Re:Piss-poor situation (Score:4, Insightful)

      by AuMatar ( 183847 ) on Sunday June 07, 2015 @05:06AM (#49860387)

      Better solution- make all organs automatically donated upon death. The owners don't need them anymore. Then no money needs to be involved at all, and we'd have a ready supply. The family can get what's left of the body after any usable organs have been harvested. Bonus- a system that's actually fair, rather than making money the determining factor.

      • Re:Piss-poor situation (Score:4, Informative)

        by ecotax ( 303198 ) on Sunday June 07, 2015 @06:04AM (#49860499)

        Exactly my thoughts, except that people who really have problems with this solution for religious or whatever reason should have a way to opt-out. Simply changing the default from opt-out to opt-in would already make a big difference, maybe enough, maybe not.
        If that wouldn't be enough, the deal could be that people who choose to opt-out would be placed behind people who choose opt-in in on the waiting list in case they need an organ themselves. That would be fair and still leave people the choice to opt-out if they are really uncomfortable with the whole organ donation idea (personally, I'm not - dead is dead).

        • Re: (Score:2)

          by jopsen ( 885607 )

          Exactly my thoughts, except that people who really have problems with this solution for religious or whatever reason should have a way to opt-out. Simply changing the default from opt-out to opt-in would already make a big difference, maybe enough, maybe not.

          You don't even have to go that far (opt-out is too far). Just make it a requirement that once you turn 18, you file a form opting either in or out.
          Most people who aren't organ donors are so because they haven't made up their mind.

          You could also make a requirement for a drivers license that you "make up your mind". Ie. on the form for application for drivers license, make an organ donation yes/no field and require that people pick one. Sort of appropriate as considering how people drive in the US, they a

          • Re: (Score:2)

            by ecotax ( 303198 )

            Agreed, if you'd find a way to have most people make up their mind that might be enough. Combining it with a drivers license would make sure that 90-something percent of the people would at least think about it once.

            And as for driving habits and risks.... You could do a lot worse than live in the US, trust me.

      • Does you idea include skin donations for grafts and burn victims?

      • I was skeptical that that would increase supply enough, but surprisingly, it would*. Only 40% of people are registered as donors, which covers more than half of the necessary transplants. Supply exists to meet demand, but people just don't register. That's disappointing.

        Honestly, though, this is one case where technology has the potential to solve a problem, and it happens to be more palatable. And if organs could be grown from a person's own tissue, rejection would be a non-issue as well, which would b

    • You really don't need the invisible hand of the market to fix everything. A much more sensible solution, for example, would be to find ways more people would agree to be organ donors after death.
      For example, switching the default from opt-in to opt-out [medicalnewstoday.com] would make a significant difference in organ availability without actually forcing anyone to make a choice they're not comfortable with or could have an adverse influence on their health.

    • I got mugged they stole my cellphone my wallet and a kidney!

      The reason why paying for organs is dangerious is it offers a revenue source towards a scares system. There will be a lot of people not willing to sell their kidney at any price. So we will have a market where the price will not match demand and supply. When things are not balanced you will get factors often via black market to try to get it balanced. So taking kidneys from unwilling victims, where the price is high enough to take the risk of doi

    • Oh yeah, how about going a step further? Mortgage your organs. And if you can't pay, hey, at least the bank will be happy. You'll see Paris! Ok, not you, but your eyes will!

      And it's just so perfectly capitalist. Poor people donate, rich people may live. Hey, supply and demand, you see?

      Repo comes alive!

    • OR...we could get good at GMO technology and develop pigs that grow human organs cloned from specific people in need, so that after transplantation you wouldn't have to spend the rest of your life with no more immune system.

      An interesting long-term effect of technology like this would be the gradual displacement of the anti-GMO crowd by adverse selection.

    • Re: (Score:2)

      by jabuzz ( 182671 )

      There is a simple answer to the shortage of organs. At the moment there is no downside to not being on the "register" or whatever it is in your country. Therefore to fix the supply problem we need to create a downside if you are not a registered organ donor.

      The most objectively fair way to do this is if you are not on the donor register you are ineligible to receive a donated organ. Put simply if you are not willing to donate an organ what makes you think you should receive them?

      Obviously we need to require

    • "Maybe we should just allow people to buy kidneys"

      Hello organlegging.

  • Like a wife swap. Just two of you, and it's quite possible the swap won't be fun because at least one pair doesn't hit it off. But bring 10 couples together and the chances of finding a way to pair everyone up so that they have a good time is a lot better.

    You know. In theory.

  • This made headlines because it's the longest cycle ever, but the people who run these programmes see long cycles as undesirable -- what they mostly do is identify hundreds of opportunities for two or three way swaps, or for "open" chains where one altruistic donor can result in two or three people getting kidneys. The maths behind it is quite interesting.

    • Re: (Score:2)

      by mwvdlee ( 775178 )

      I'm guessing shorter chains make it more likely for the donors involved to agree, as it's less "anonymous".
      Also; why make these chains any longer than necessary.
      At the end of the day though, these chains should be as long as necessary, and I'm thoroughly impressed by the organisational skills involved here and the willingness of the donors to go through with it.

      • Re: (Score:2)

        by dj245 ( 732906 )

        I'm guessing shorter chains make it more likely for the donors involved to agree, as it's less "anonymous". Also; why make these chains any longer than necessary. At the end of the day though, these chains should be as long as necessary, and I'm thoroughly impressed by the organisational skills involved here and the willingness of the donors to go through with it.

        I think it has more to due with what happens when a kidney is rejected. With a single swap, if things go bad, that is tragic but the two matches probably got to know each other a little bit. With a long chain, the chances of at least one of the kidneys being rejected increases, and the politics may get more complicated when that happens.

      • The other complication is that all surgeries in a cycle have to be simultaneous -- to avoid allowing donors to opt out after their relative has received a new kidney. So in this case you need 18 operating theatres and 18 surgical teams.

  • i'm hopeful that soon we will be replacing our organs with regrown versions of our own. they are making excellent progress in this field. [soylentnews.org]

  • Doctors especially older ones hate Electronic Health Records (EHR), they don't understand why they should use them, it takes longer to enter the data, they don't get any additional detail from the patient, it just seems a waste of time and money.

    But the key advantage is when you can do analysts on the data, find matches and trends. Not on one patient but on a population. If I were willing to donate, it shouldn't be because one person needs it at that location it should be a wider search.

    • Doctors don't like the move to electronic records because it threatens the medical cartel. They see only too well what the Internet has done for Fungibility Of Things.

      • Doctors don't like the move to electronic records because it threatens the medical cartel. They see only too well what the Internet has done for Fungibility Of Things.

        .....because greed and racism are the only reasons someone would dare disagree with Obama and Democratic party decrees.

  • Why transport the kidneys? (Score:1)

    by Anonymous Coward

    Why do they transport some of the kidneys between hospitals instead of putting the donar and the recipient in the same hospital? It adds an additional risk factor for no benefit, as far as I can see.

  • A lot of the posters are missing the point here.

    These are live donors who have joined a group of other live donors who made a promise to give a kidney now (while they are alive) in return for a kidney to be donated to a loved one in the near future (as the case may be). With the advent of national databases they were able to find a sequence of matches (involving 9 donors) so that they were able to get a kidney donated to their loved ones.

    This is more a networking or graph design problem than a organ donati

  • I think more people should look into this and other donations.. I've donated a kidney and am on the Bone Marrow Donor registry (http://bethematch.org/ [bethematch.org])

    The three times I've cried in my life: Wedding day, birth of child, and walking to meet my kidney recipient after the operation.

    I went through the Transplant Facility at MUSC (Medical University of South Carolina). The operations, while major, are somewhat common and straight forward. I never doubted anything would go wrong, and to be honest, I'd do it

  • As good and impressive as this is, in 2012, there was a "chain" of 60 people, 30 kidneys,
    transplanted... It's quite amazing.

    http://www.nytimes.com/2012/02... [nytimes.com]

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