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Last Friday there was a 5-way kidney swap, where five unrelated donors’ kidneys were transferred into unknown recipients. Each recipient had been having difficulty finding a compatible donor in their immediate family, which is the usual source. What made this swap with strangers possible was a compatibility data-bank. People were found who were unwilling to give their kidney to a stranger but were willing to give one to a family member, but as is usually the case they were incompatible with the family member who needed it. A computer search of the compatibility of a large number of potential donors and recipients discovered a situation where a multiple exchange could be done so each person in need would receive an appropriate kidney. It is a good outcome for everyone because the donor’s family member receives a good kidney which they could not give directly.

The problem for kidney donors is that they need their vital organs, and even if nature has provided them with a second one it may turn out later that it is needed for their own survival. Therefore, the donor must be highly motivated to maintain the health and life of the recipient. It is a much higher level of motivation than almost anyone is willing to offer to the general public. And rightly so because in addition to losing some life expectancy from not having a backup kidney there is a risk of suffering, injury and death from the medical procedure itself.

Here is how the problems for the donor may be solved for giving a kidney or other vital organ to a person in need. First, make it possible for the donors to get a new kidney easily and free as part of their donation agreement. At any time in the future when they needed a kidney, they would automatically rise to the very top of the priority list of potential recipients, and they would be given the kidney and the procedure free of charge. Second, they should be given a large sum of money for their kidney and the risks they are taking. This usually isn’t done to prevent desperate people from being exploited by an unethical system, so there must be an ethics committee of responsible judges permitting these operations. Third, the donor’s identity must be known but kept in a secret data-bank and be unrelated to anyone involved to the situation to prevent any kind of forcing or blackmail or the importation of organs from unknown sources. Fourth, a very large sample of the public should be enrolled in the program so that any donor is very unlikely to be called to contribute. Lastly, the donor should have the option of backing out of the operation without any sort of penalty. The default option whenever blood is drawn is that the person’s compatibility for organ donor enters the data-base. They always have the right of refusal, but at some time in the future they might change their mind, if contacted.

Everyone’s compatibility should be known to a closed data-bank.