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Donate a Kidney Now; Get a Voucher for One Later

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Howard Broadman, a lawyer and retired judge from California, knows his grandson, Quinn, will probably one day require a kidney transplant.

By the time Quinn needs his help, however, Broadman said he may be dead or too old to donate a healthy organ.

"I approached UCLA and asked, 'Why don't I give a kidney to someone who needs it now, then get a voucher for my grandson to use when he needs a transplant in the future?' And that's just what we did," Broadman said in a statement.

How the program works

Broadman worked with Dr. Jeffrey Veale, a transplant surgeon who helped initiate the program at the Ronald Reagan UCLA Medical Center.

The voucher program is relatively simple.

A person donates their kidney and selects a recipient for a future donation.

The recipient receives a voucher that can be used if they need a living kidney donation. Living kidney donations are made when a person who is alive donates one of their two kidneys and goes on living with the remaining one.

The program could change the face of kidney donation in the United States, bringing more donors to the operating table.

Essentially, you donate when it is convenient and others receive if it's necessary, Veale told Healthline.

The American Society of Transplant Surgeons has endorsed the program, which is being used at nine other transplant programs across the United States under the umbrella of the National Kidney Registry (NKR).

There are 26 million people with chronic kidney disease in the United States. Some may progress to end-stage renal disease and would be ideal candidates for transplant, the National Kidney Foundation reports.

There also are 500,000 people in the U.S. with a functioning transplanted kidney. The new organ typically lasts 10 to 20 years.

Risks, logistics, and legalities

Ruthanne Leishman, who heads up the Kidney Paired Donation program for United Network for Organ Sharing (UNOS), said transplant surgery comes with pain and a risk of infection.
There is, however, only a low risk of death.

There is a waiting list for deceased donations but not for living donations, Leishman said. Her organization manages deceased donor allocation on behalf of the Health Resources and Services Administration, an arm of the Department of Health and Human Services.

Unlike donations from the deceased, which only go through UNOS, living donations go through a variety of organizations such as the NKR.

Veale told Healthline that a donor can add up to five people onto a voucher. Potential recipients must have kidney disease and the voucher can be used only by the first person who needs it.

For some families with genetic polycystic kidney disease, they usually know someone will need a transplant in the future, so being able to name multiple possible recipients can be helpful.

"Whoever would need the transplant first, the voucher would go to that person," Veale said.

Vouchers are not transferable and they expire when the donor passes away. In that case, if the recipient does not use it, the donation becomes altruistic, meaning it would go to a stranger instead of a specified recipient.

Vouchers cannot be sold to another person and cannot be withdrawn.

To make sure the recipient is who they say they are, doctors complete human leukocyte antigen (HLA) typing and record the recipient's blood type -- a sort of blood fingerprinting system.

The future of kidney donation

Veale said he hopes the program may spur more altruistic donations, too.
"The demand for kidney transplant is tremendous," Veale said. "For the first time in history we could actually start reducing the waiting [deceased donor] list."

Living organ donation is essential to increase the supply of available organs, and help more than 100,000 Americans waiting for a transplant, said Kevin Longino, chief executive officer of the National Kidney Foundation.

In 2014, there were 5,538 living donor kidney transplants in the United States.

"The voucher program through UCLA is an interesting idea that builds upon paired donor exchange, although many more details need to be unveiled, such as how the voucher program will be monitored and enforced, to best protect the needs of the donor and recipient," Longino told Healthline.

Dr. Tim Taber, transplant nephrologist and the medical director for the kidney transplant program at Indiana University Health, said it would be interesting if university-affiliated hospitals could run similar programs on their own without a national organization.

Universities may be more likely to be around in the future to honor vouchers for recipients getting kidneys decades down the road.

"You have to give to an organization that you know will be there in time," he said.

Other than that, Taber thinks that the program will get more kidneys into the system, which is clearly needed as 13 people die each day waiting for a transplant.

For Broadman, the program has been rewarding -- mainly because he can help his grandson.
"I may not even be here when he realizes it, but I changed his life," he said. "It doesn't get much better than that."

By Kristen Fischer

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