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Evolving swaps in transplantation

global exchange, vouchers, liver, and trans-organ paired exchange

Lo, Alexis L.a; Sonnenberg, Elizabeth M.b; Abt, Peter L.b

Current Opinion in Organ Transplantation: April 2019 - Volume 24 - Issue 2 - p 161–166
doi: 10.1097/MOT.0000000000000621

Purpose of review With the ongoing organ shortage, several mechanisms to facilitate organ exchanges and expand the scope of living kidney or liver donation have been proposed. Although each addresses at least one barrier to transplantation, these innovative programs raise important ethical, logistical, and regulatory considerations.

Recent findings This review addresses four recent proposals to expand living donor transplantation. For kidney transplantation, we discuss global paired exchange and advanced donation programs (’vouchers’) and for liver transplantation, liver paired exchange. Lastly, this review considers trans-organ exchange. We explore the conceptual framework of the exchange, current status, benefits, and concerns for implementation among each of these evolving pathways.

Summary Through highlighting novel mechanisms in organ exchange, greater awareness, discussion, or support can occur to create more avenues for transplantation. These innovative mechanisms require regulations and safeguards for donors to ensure informed consent, and proper follow-up is maintained.

aLewis Katz School of Medicine, Temple University

bDepartment of Surgery, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA

Correspondence to Peter L. Abt, Department of Surgery, Hospital of the University of Pennsylvania, Perelman School of Medicine, Transplant-2 Ravdin Courtyard, 3400 Spruce Street, Philadelphia, PA 19104, USA. Tel: +1 215 662 2094; fax: +1 215 615 5201; e-mail:

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