University of Toledo Medical Center, Toledo, OH, USA; Alliance for Paired Donation, Perrysburg, OH, USA.
University of Minnesota, Minneapolis, MN, USA.
Eur Urol Focus. 2018 Mar;4(2):190-197. doi: 10.1016/j.euf.2018.07.021. Epub 2018 Aug 23.
Global Kidney Exchange (GKE) offers an opportunity to expand living renal transplantation internationally to patients without financial means. These international pairs are entered into a US kidney exchange program that provides long-term financial support in an effort to identify opportunities for suitable exchanges for both these international pairs and US citizens.
While the promise of GKE is significant, it has been met with ethical criticism since its inception in 2015. This paper aims to demonstrate the selection process and provide >3 yr of follow-up on the first GKE donor and recipient from the Philippines.
DESIGN, SETTING, AND PARTICIPANTS: The first GKE transplant occurred with a young Filipino husband and wife who were immunologically compatible, but lacked the financial means to continue hemodialysis or undergo a kidney transplant in their home country. The pair was enrolled in the Alliance for Paired Donation matching system, several alternative kidney exchanges were identified, and the pair subsequently underwent renal transplantation and donation in the USA financed by philanthropy. The resulting nonsimultaneous extended altruistic chain provided transplantation for the Filipino husband and 11 US patients.
The Filipino donor and recipient were followed by transplant professionals in both the Philippines and the USA. Follow-up data were maintained as required by the Organ Procurement and Transplantation Network in the USA.
The Filipino donor has normal blood pressure and renal function, and the Filipino recipient is doing well 3.5 yr after their donation and transplantation.
While criticisms of GKE highlight concerns for possible exploitation of financially disadvantaged groups, these results demonstrate that these concerns did not come to fruition, and the outcome experienced by the GKE donor and recipient (and other US participants) was successful.
The first Filipino Global Kidney Exchange (GKE) donor-recipient pair continues to be followed by both US and Filipino transplant centers. Both are in good health, support the GKE program, and advocate for its expansion.
全球肾脏交换（GKE）为没有经济手段的患者在国际上扩大活体肾移植提供了机会。这些国际对在进入美国肾脏交换计划后，将获得长期的经济支持，以努力为这些国际对和美国公民找到合适的交换机会。
虽然 GKE 的前景非常广阔，但自 2015 年成立以来，它一直受到伦理批评。本文旨在展示选择过程，并提供来自菲律宾的第一对 GKE 供体和受者的 >3 年随访结果。
设计、地点和参与者：第一例 GKE 移植发生在一对年轻的菲律宾夫妇身上，他们在免疫上是相容的，但在他们的祖国缺乏继续进行血液透析或接受肾脏移植的经济手段。这对夫妇被纳入了配对捐赠联盟的匹配系统，确定了几个替代肾脏交换方案，随后这对夫妇在美国接受了慈善捐赠资助的肾脏移植和捐赠。由此产生的非同时扩展利他主义链为菲律宾丈夫和 11 名美国患者提供了移植机会。
菲律宾的供体和受者都由菲律宾和美国的移植专业人员进行随访。随访数据按照美国器官获取和移植网络的要求进行维护。
菲律宾供体血压和肾功能正常，菲律宾受者在捐赠和移植后 3.5 年情况良好。
虽然对 GKE 的批评强调了对经济弱势群体可能被剥削的担忧，但这些结果表明，这些担忧并没有成为现实，GKE 供体和受者（和其他美国参与者）的结果是成功的。
第一对菲律宾全球肾脏交换（GKE）供体-受者对仍由美国和菲律宾的移植中心进行随访。他们都身体健康，支持 GKE 计划，并倡导扩大该计划。
