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Mix, match, and switch: Kidney exchanges between strangers

Rating

3 Star

Mix, match, and switch: Kidney exchanges between strangers

Our Review Summary

The article describes paired organ donation, which might increase the number of people who are able to receive organ transplants, particularly those who have hard-to-match blood or tissue types. The article does a nice job of describing the availability and history of this practice and just what it is. However, the article is overly dramatic, anecdotal, and paints transplantation in a very rosy light. Perhaps the biggest limitation of this story is the minimizing of harms from transplantation, which could include risks of surgery and risks of life-long immunosuppresive treatment and/or organ failure. The risks to the donor are particularly minimized, considering a donor is generally a healthy volunteer undergoing a serious medical procedure that is not required to save his or her life. These implications are not even hinted at. Adding to the unbalanced nature of the story is the fact that all sources of information were experts connected to transplants, mostly transplant surgeons involved in swapping. The story does not obtain any perspective from someone who may think organ swapping may violate current laws, which is the reason stated for needing clarifying legislature.

The article does not mention any costs, including who pays for travel, hospital, physician, or immunosuppresant medication expenses. Also, the kidney swap program entails huge logistical hurdles/challenges, as not every medical center can afford/provide 4 transplant teams working simultaneously; the swap entails 4 hospital rooms, 4 surgical teams, etc.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The article does not mention any costs, including who pays for travel, hospital, physician, or immunosuppresant medication expenses. Also, the kidney swap program entails huge logistical hurdles/challenges, as not every medical center can afford/provide 4 transplant teams working simultaneously; the swap entails 4 hospital rooms, 4 surgical teams, etc.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory

An important benefit for people to know who may be thinking about this would be their chance of kidney survival with a live-organ donation. Those numbers are provided (84% at 5 years for live-donor kidneys). Another benefit of interest would be how many more people might be able to receive a transplant through organ swapping. Those estimates are provided, although they are based on theoretical modeling. Interestingly, large numbers of people are required to increase the number of matches made, and even then, the increases are quite small.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

The story doesn’t mention harms of transplant at all. Harms could include those from surgery itself, like problems with anesthesia, infection, and bleeding, and harms also include life-long effects of immunosuppresive therapy, which increase risk for infection, involve taking drugs every day for the rest of your life, and have other side effects. The story paints a very rosy picture of transplantation and is not balanced. One patient who is donating her kidney claims it’s “just a 3 inch incision,” which minimizes what’s involved, especially for the donor. Often, donors have more pain post-operatively and a longer recovery period than the recipients. Plus, this quote minimizes other potential harms to the donor, such as what happens if her one remaining kidney fails?

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The article reports a little about the evidence for organ swaps, mentioning a JAMA article that claims swaps can increase the number of live-donor transplants (vs. cadaver) by six-fold, but the type of research this claim is based on is unknown. There is no description of the strength of the study mentioned. Readers might also want to know how a live-donor transplant improves survival compared to traditional cadaver transplants. However, the story does not describe the type of evidence to support the data reported (e.g. how strong are these findings?).

Does the story commit disease-mongering?

Satisfactory

The story describes how many people are on waiting lists for kidney transplants.

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

Although several sources are quoted, all of them have some connection to organ swapping and all of them praise it. It’s not clear if the reporter sought any independent opinion from physicians not directly tied to organ-swapping transplant efforts. The story does not obtain any perspective from someone who may think organ swapping may violate current laws, which is the reason stated for needing clarifying legislature.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The story describes the primary treatment option for people with kidney failure, that is dialysis. However, the article doesn’t describe it any more than naming it. There is no assessment of effectiveness of dialysis and, indeed, it is painted in a very negative manner – “…slowly dying on dialysis.” While dialysis is by no means a cure, it does allow people to live who would otherwise die due to kidney failure.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The article discusses several consortia or organizations of hospitals that participate in paired matching of organs. Based on the limited number of participating hospitals in selected regions, it seems clear this is not widely available at present. Plus, the article mentions that legislation is needed before a federally funded organ donation organization (UNOS) could get involved, potentially making this much more widely available.

Does the story establish the true novelty of the approach?

Satisfactory

The story explains when the first paired organ donation took place, letting readers know this is not “new,” per se, although a national policy allowing widespread paired organ donation would be new.

Does the story appear to rely solely or largely on a news release?

Satisfactory

Because several different sources are used in the story, it appears that it did not rely solely or largely on a news release.

Total Score: 5 of 10 Satisfactory

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