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How an Economist's Idea for Kidney Transplant Chains Has Saved Lives

The method facilitates match-ups of donors and patients

By PBS NewsHour

(Editor's note: This story previously appeared on PBS NewsHour.)

What happens if you need a kidney transplant and don’t know someone who is a biological match? A Nobel prize-winning economist has a solution: transplant chains. Donors agree to give to a stranger in exchange for a kidney for their loved one, but it has to start with someone willing to give without getting anything in return. PBS NewsHour's Paul Solman has the story of two donors who volunteered to do just that. Here is a transcript of the story as well as the video:

Amna Nawaz: There are more than 100,000 people in this country waiting for a kidney transplant, and the median wait time is more than three years. A Nobel Prize-winning economist has a solution: kidney transplant chains. It starts with a donor giving to a stranger with nothing guaranteed in return. And the momentum builds from there.

Paul Solman has the story of two donors who volunteered to start a chain, saving multiple lives, part of our weekly series Making Sense.

Barbara Sine: Emotionally, I'm feeling a little bit anxious.

Woman: Knock knock. Good morning.

Sine: Hello.

Paul Solman: That was Barbara Sine back in October, minutes before surgery at Saint Barnabas Medical Center in New Jersey.

Sine: Scary.

Solman: Sine, a 53-year-old mother of two, works at a prep school, teaches spin classes on the side, is healthy as a horse. Her operation was 100 percent elective, and yet lifesaving. It was all due to a story on NPR.

Sine: I actually brought my husband in the car. I made him listen to that podcast and that interview. And I said, I have to do this. And — and I — still to this day, it gets me very emotional.

Solman: So that was you?

Alvin Roth: On the "Freakonomics" broadcast, yes.

Solman: Turns out Barbara Sine and those like her are key players in a medical revolution, and economics Nobel laureate Alvin Roth deserves much of the credit.

As a market expert, he'd been puzzling over how to increase the number of kidney transplants. Dialysis keeps patients alive while they wait, usually years, for a deceased donor kidney, or, if they're lucky, a kidney from a living donor who's a good biological match.

And then Al Roth says he heard about two spouses chatting in the waiting room of a dialysis clinic.

Roth: Why are you here? I'm waiting for my husband. I would give him my kidney, but he has blood type B and I have blood type A. Oh, it's a funny thing. My — you know, we're just that reverse.

Solman: So the wife with blood type A gave one of her two kidneys — we can live with just one — to the other spouse. And her blood type B husband got a kidney from the person she'd met in the waiting room.

But Roth saw a way to go beyond two couples swapping two kidneys, by using computer algorithms to create donor-recipient chains, matched for blood and tissue type, even for age.

One problem, though, everyone needing a kidney also needed a partner to donate a kidney to another pair. A second problem, all the operations had to happen simultaneously.

Roth: Just to make sure that no link is broken. What wouldn't be good is if you give a kidney to my brother today and tomorrow, for whatever reason, I fail to give a kidney to your sister. You had a surgery that didn't help your sister, and you can't take part in next kidney exchange because you no longer have a kidney to exchange. You have already given yours.

Solman: And that created a logistical logjam.

Roth: What that means is, that if you want to do even that simple exchange, you need four operating rooms and four surgical teams to be available at the same time. To do a three-way exchange, you would need six operating rooms.

To do a four-way exchange, you would need eight operating rooms.

Solman: There was, however, a solution.

Roth: It turns out there are a couple hundred people a year in the United States who want to give a kidney to someone who don't have a particular patient in mind.

We have learned how to use them to start chains of transplants, where they give to a patient donor pair, and the donor in that pair gives to someone else, who gives to someone else.

And each pair gets a kidney before they give one, because, if I fail to give a kidney, the patient I was supposed to give a kidney to will be very disappointed. But their donor will still have his or her kidney. So they can wait for the next opportunity.

Solman: And all this because of just one non-directed donor, like Barbara Sine.

Sine: I think, prior to this, if I had known someone who needed a kidney, I'm sure I would have stepped up. But I don't know anybody. So I can just kind of throw it up there to fate and let it land where it may.

Solman: What's different about you? I mean, it's so unusual to have someone altruistically give a kidney.

Sine: I'm a hospice volunteer. I foster animals. So I think this is kind of a continuation, maybe at a different level.

Solman: Twenty-six-year-old Eric Walano gives blood regularly.

Eric Walano: I actually just finished up my fourth gallon.

Solman: Takes a homeless a man he's befriended to lunch.

Walano: And we go to Five Guys sometimes.

Solman: Walano too is a non-directed kidney donor.

Walano: So, about a year and a month ago, I went to a charity organ donation gala type thing. And I turned to my parents and I was like, kidney donation, I can do that.

Solman: And they said?

Walano: And they said, you're crazy and probably a little bit drunk. What if, God forbid, something happens to my other kidney down the road? And then a month later, I was in Saint Barnabas.

Solman: Undergoing rigorous physical and psychological evaluation. He was cleared to donate, gave a kidney in April. But to whom? As the months passed…

Walano: I was in a little bit of a funk. I was like, ah. It was like, why am I a little bit sadder today? What am I missing?

Solman: Because it was a feeling of irresolution or not having been acknowledged.

Walano: That's perfect. Yes, you hit the nail on the head.

Solman: And you weren't getting anything back.

Walano: And I didn't get anything back.

Solman: No wonder that of the thousand or so people who contact Saint Barnabas each year about living donation, only 1 percent are would-be non-directed donors. And only half of those area approved, says clinical director Marie Morgievich.

Marie Morgievich: They want to help another person, because they're good people. But maybe it's just not the right time for them to come forward.

Solman: Meanwhile, the waiting list for cadaver kidneys, 2,500 people at Saint Barnabas alone, 100,000 or more nationwide, keeps growing, growing faster than deceased donor organs come in.

Morgievich: We will do approximately 170 deceased donor kidney transplants, but we will add 400 or more candidates to that list. So we know that we're in a losing battle.

Man: My hope was down here, and every day was darker and darker.

Solman: 39-year-old Rosario Davi was on dialysis over a year.

Man: I could do 10 percent of what I used to do physically. Mentally, that demon's on your shoulder the whole time through this process.

Solman: But, last April, Eric Walano sent Davi's demon packing.

Man: It's an angel on Earth. I don't know what else to say.


Solman: And, in December, Walano finally did get something back, when he was allowed to meet his kidney's new owner, and the entire transplant chain his gift had set in motion.

Woman: It's just so unfathomable that you would go through this process of having the surgery and the recovery time for a complete stranger.

Solman: But after Rosario got Eric's kidney, his wife, Tara, also gave to a complete stranger, Michael Dunn in California.

Man: You're such a blessing to do what you did, to sacrifice the way you did. And I'm very grateful.


Solman: Michael's wife, Sandy, gave a kidney to Eduard Cardenas-Rios.

Woman: How are you feeling?

Man: I'm feeling very well.

Woman: Yes?

Man: Yes. I was on dialysis for seven years.

Woman: Oh, my God. Whoa. To be able to give it to someone that needed it so much, it just — it just makes me really happy.

Woman: Can I just say something to her?

Solman: Eduard's sister, Ines.

Ines Cardenas-Rios: He has a life to look forward to now. And it just means everything to me and my family. I just wanted you to know that.

Solman: And Ines Cardenas-Rios donated a kidney that's keeping Leo Lunney alive.

Man: And I'm the biggest person in the room and the most emotional, so…


Solman: His brother, Richard, had agreed to donate a kidney on Leo's behalf. It went to Leslie Naples.

Woman: It's working great. Yay!


Solman: Leslie's had kidney disease for 23 years.

Woman: I want to say that I love you, because I do.

Man: I love you too.

Man: One more hug.

Man: I love you too.



Man: I'm Leslie's husband, Rick.

Solman: Rick Naples donated a kidney, ending the chain, to perhaps the luckiest recipient of all, Sharon Bloch of California.

With a hard-to-match blood type, and no one to donate on her behalf, she's been on dialysis, and deceased donor waiting lists, for years.

Sharon Bloch: My son is 8 years old. And I kept promising him I will eventually get a kidney, and you will see a different mom. I even flew here one time because there was a kidney. Got to the airport here, and turned around and went back, because it fell through, right? Yes.

So, when this happened, it was like…

Woman: A miracle.

Bloch: It was — yes.

Woman: Well, Eric, just take a look and look what you have created. All of these people's lives have been changed.

Man: Bigger family.


Walano: I'm going to take this picture from today, and I'm going to put that up. That's going to be the trophy case now.

Solman: Meanwhile, Barbara Sine has yet to meet her recipient.

Sine: I know that a man about my age got my kidney, and I do know that his wife was scheduled to donate, I think, the following week. And that's about all I know.

Solman: Would you be more and more happy as a function of whether or not more and more people were in your chain?

Sine: Well, yes, I mean, I think the more people who are helped, the better. The idea that it can — I can help 10, 15, who knows.

Solman: And, bottom line, that's what makes this tear-jerker an economics lesson as well.

Roth: Altruism seems to respond to some of the economic incentives that other goods do. If you can do more good with a dollar, you're more likely to give a second dollar.

Solman: OK, you can't give a second kidney. But you can sure do a world of good giving just one.

This is economics correspondent Paul Solman reporting from New Jersey.

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