CALGARY - Canada and the United States should have a joint kidney registry that would enable the largest number of people to get well-matched organs as quickly as possible, says a doctor with ties to both sides of the border.
Jeffrey Veale, a University of Calgary-educated doctor who now works in Los Angeles, is one of the first physicians involved in chain-reaction kidney donations based on the idea of paying it forward.
The chain starts with an altruistic donor who gives a kidney to someone with a relative who wanted to donate but wasn't a match. That relative's kidney is then donated to a stranger in the same situation, and the chain reaction continues for as long as possible.
Veale says there's no reason such a chain couldn't extend between Canada and the U.S. to give patients the best shot at a well-matched kidney as quickly as possible.
"It could potentially happen in Canada, or it could cross the border," he said Thursday in Calgary.
"I can't see why if we can ship oranges and cars between Canada and the United States, (we couldn't) start shipping some of these life-saving organs between the two countries."
Earlier this year, Canada launched its first national living donor kidney registry, which aims to connect people who need kidneys and their relatives who are willing to donate but aren't a match with others who are in the same boat.
So far, the registry is focusing on exchanges where several donors are matched and transplants done at the same time, called domino transplants.
In the altruistic chains, transplants can continue for months, picking up new donors along the way.
It's unclear which method is better, said Dr. Ed Cole, whose team performed one of the domino surgeries through Toronto's University Health Network.
"It's relatively new. I'm not sure what the answer is, but there are certainly some people who believe that the domino paired exchanges, which is what we're actively doing in Canada, is perhaps a better way to go for the moment," he said.
Altruistic chains may involve more patients, but they can also leave a donor waiting for months to find a recipient, he said. This can cause people to back out and break the chain.
"The plus is that you can get what they call a never-ending chain, the minus is the donor has to hang around for who knows how long being available."
It's a little early to start considering a cross-border exchange of kidneys, said Steve Brule, executive director for organ registries at Canadian Blood Services, which runs the Canadian registry.
The U.S. National Kidney Registry has actually asked whether Canadian Blood Services would consider a merged list for domino transplants, he wrote in an email.
"The thinking is valid. However, in our opinion, we just aren't ready for that kind of conversation," he said.
"We are still trying to roll this out across Canada ... And, given the challenges we are having addressing privacy issues with a national registry, I couldn't imagine the difficulties we would need to tackle for a (cross)-border exchange."
Veale says while domino exchanges are a good start, a longer altruistic chain allows for better matches over a longer period of time.
When a limited number of patients is involved, it's not always possible to get the best match possible, he said, and research has shown that the better a match, the longer a kidney will last.
Altruistic chains could theoretically stretch to hundreds of patients, each one chosen for both the compatibility of the organ and their ability to continue the chain.
"A chain can create a better quantity and better quality of kidney transplants. It become mathematical -- you have a much better chance of matching in a chain than you do in a paired donation," he said.
