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Vouchers for Future Kidney Transplants to Overcome “Chronological Incompatibility” Between Living Donors and Recipients

Veale, Jeffrey L. MD1; Capron, Alexander M. LLB, MA (Hon)2,3; Nassiri, Nima MD3; Danovitch, Gabriel MD1; Gritsch, H. Albin MD1; Waterman, Amy PhD1; Del Pizzo, Joseph MD4; Hu, Jim C. MD, MPH4; Pycia, Marek PhD5; McGuire, Suzanne RN, BSN1; Charlton, Marian RN4; Kapur, Sandip MD4

doi: 10.1097/TP.0000000000001744
Original Clinical Science—General
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Background The waiting list for kidney transplantation is long. The creation of “vouchers” for future kidney transplants enables living donation to occur when optimal for the donor and transplantation to occur later, when and if needed by the recipient.

Methods The donation of a kidney at a time that is optimal for the donor generates a “voucher” that only a specified recipient may redeem later when needed. The voucher provides the recipient with priority in being matched with a living donor from the end of a future transplantation chain. Besides its use in persons of advancing age with a limited window for donation, vouchers remove a disincentive to kidney donation, namely, a reluctance to donate now lest one’s family member should need a transplant in the future.

Results We describe the first three voucher cases, in which advancing age might otherwise have deprived the donors the opportunity to provide a kidney to a family member. These 3 voucher donations functioned in a nondirected fashion and triggered 25 transplants through kidney paired donation across the United States.

Conclusions The provision of a voucher to potential recipients whose need for a transplant makes them “chronologically incompatible” with their donors may increase the number of living donor transplants.

Creation of “vouchers” that can be “redeemed” for future kidney transplants facilitates living donation at a time optimal for the donor and recipient. Three nondirected individual vouchers triggered 25 transplants through kidney paired donation across the United States.

1 David Geffen School of Medicine at UCLA, Los Angeles, CA.

2 Gould School of Law, USC, Los Angeles, CA.

3 Keck School of Medicine, USC, Los Angeles, CA.

4 New York–Presbyterian Weill Cornell Medical Center, New York, CA.

5 Department of Economics, UCLA, Los Angeles, CA.

Received 8 January 2017. Revision received 22 February 2017.

Accepted 12 March 2017.

Jeffrey L. Veale, MD, Suzanne McGuire, RN, BSN, Marian Charlton, RN, and Sandip Kapur, MD are on the National Kidney Registry Medical Board. None of the other authors disclose any funding or conflicts of interest.

J.L.V.: manuscript development, data interpretation, literature search, writing, figure development. A.M.C.: manuscript development, writing, literature search, medico-legal counsel. N.N.: manuscript development, literature search, writing, figure development, data interpretation. G.M.D.: manuscript development, writing. H.A.G.: manuscript development, writing. A.W.: manuscript development, writing. J.D-P.: manuscript development. J.C.H.: manuscript development. M.P.: manuscript development, writing, medical economics counsel. S.M.: manuscript development, writing. M.C.: manuscript development. S.K.: manuscript development.

Correspondence: Jeffrey L. Veale, MD, UCLA Kidney Transplantation Exchange Program, David Geffen School of Medicine at UCLA, 200 Medical Plaza, Suite 140, Los Angeles, CA 90095-1738. (

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