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The economic principle that powers this kidney donor market

A hundred thousand Americans are on a waiting list for a kidney from a deceased donor. But another option is the paired-organ exchange, which allows living kidney donors who are not a match with their intended recipient to network with others who are. Economics correspondent Paul Solman reports.

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  • Judy Woodruff:

    Now, economics correspondent Paul Solman looks at a market trading in a commodity too precious to put a price on. The paired-organ exchange allows living kidney donors who are not a match with their intended recipient to network with others who are. It's this week's installment of our "Making Sense" economic series.

  • Melanie Melillo:

    Look how pretty, Rob.

  • Paul Solman:

    Rob and Melanie Melillo's 21st wedding anniversary. A bit less dramatic than their 20th.

  • Melanie Melillo:

    He got a piece of steak stuck in his throat, and he looked at me with this face and I did the Heimlich, and I said to him I just saved your life twice.

  • Paul Solman:

    Once from choking.

  • Melanie Melillo:

    You lucky dog.

  • Rob Melillo:

    C'mon.

  • Paul Solman:

    The second time, however, is still to come, to save Rob from a hereditary disease that's destroying his kidneys, and forced him, last August, to join 100,000 other Americans on a waiting list for a kidney from a deceased donor.

    How long did they say you would probably have to wait?

  • Rob Melillo:

    When they first listed me I was at three to five years. Now I went for my one year checkup and they said it got bumped to four to seven years.

  • Paul Solman:

    Even though, in this last year, his health has continued to decline, making it harder and harder for him to keep working as a plumber.

  • Rob Melillo:

    About four hours worth of work and I'm dragging.

  • Paul Solman:

    So, Melanie was ready to give one of her kidneys to Rob.

  • Melanie Melillo:

    I said I'd give it if I could. The nurse said, well, you can.

  • Paul Solman:

    But, it turned out, not to Rob directly.

  • Melanie Melillo:

    Give me that jog in place!

  • Paul Solman:

    At age 47, this fitness instructor has kidneys that support a body able to run rings around the rest of us. Problem is, Melanie is a type A, blood type, that is, meaning she can only donate a kidney to someone with type A or type AB blood.

    But Rob is type O, meaning he can receive a kidney only from someone with type O blood. The key to this story, however, is that even though Rob's body would reject Melanie's kidney, they learned that economics has come up with a way that she can donate for him.

  • Alvin E. Roth:

    Sometimes you're healthy enough to give a kidney but you can't give it to the person you love, and this is what opens up the possibility of exchange.

  • Paul Solman:

    It's a process called paired exchange, and economist Al Roth won a Nobel Prize for coming up with the idea more than a decade ago, a market for kidneys, but non-cash, since buying and selling organs is illegal everywhere in the world except Iran.

  • Alvin E. Roth:

    A simple kidney exchange is between two incompatible patient donor pairs, so at the top here we have a donor who would like to give to a recipient but can't because they have incompatible blood types and on the bottom, we have a blood type B donor who can't give to a blood type A recipient but they could the exchange with each other.

  • Paul Solman:

    What Roth and his team realized, the bigger the market, that is, the more pairs on the list, the greater the chance of an exchange.

  • Alvin E. Roth:

    So, it turns out that in the United States we have people who want to give someone a kidney and don't have a particular person in mind and that's actually important. We've learned how to use them to start chains of transplants where they give to a patient donor pair and the donor in that pair gives to someone else who gives to someone else who gives to someone else — long chains of transplants and that's enormously effective.

  • Paul Solman:

    The minute Rob and Melanie Melillo heard about an exchange market, they signed up at their local hospital, Westchester Medical Center, north of New York City. After months of physical exams, and for Melanie, psychological testing, they were approved.

  • Melanie Melillo:

    So, we were told that it's an average of four to six months you wait.

  • Paul Solman:

    Hey, a startling improvement on four to seven years for a deceased donor organ. Problem is, finding a kidney for Rob hasn't been as easy as anticipated.

  • Melanie Melillo:

    We've been on it for six months and we haven't heard anything.

  • Paul Solman:

    So how frustrating is it that it's been six months and nothing's happened yet?

  • Melanie Melillo:

    Very. They run the paired exchange list every Monday, and Tuesday we would find out. And every Tuesday sort of wait for the phone to ring.

  • Paul Solman:

    Waiting for word from UNOS, the United Network for Organ Sharing, that they've found an O donor for Rob. But why is that such a problem? Half the population is type O.

  • Thomas Diflo:

    Because someone who has blood type O can donate to anybody.

  • Paul Solman:

    That's Rob's would-be surgeon at Westchester, Thomas Diflo.

  • Thomas Diflo:

    So it's unlikely to have a pair where the donor is O and the recipient is something else.

  • Rob Melillo:

    So if she was an O, I would not be on the exchange list because I would just get her kidney.

  • Paul Solman:

    That's why someone with blood type O is called a universal donor. But maybe type O's shouldn't automatically give a kidney to their partner, says transplant expert Marie Morgievich, and why she tries to convince pairs with an O donor to enter an exchange instead, enlarging the pool of available organs.

  • Marie Morgievich:

    For example, we could match your recipient with a younger aged kidney or improved protein match kidney or some other variable that could help them statistically get a longer life from that transplant. And you have the option of assisting another pair or pairs that are incompatible receive transplant.

  • Nikhil Agarwal:

    It's the value of playing together.

  • Paul Solman:

    Economist Nikhil Agarwal studies the kidney paired exchange market.

  • Nikhil Agarwal:

    Imagine that you have a marketplace where all people who are willing to trade various types of goods collect and they come to the same place to conduct transactions. You might be able to find some rare transactions that you wouldn't otherwise be able to do.

  • Paul Solman:

    And first thing I learned in economics was the whole point is to make as many trades as you can possibly make because that's what a market's for.

  • Nikhil Agarwal:

    Every time you create a trade, you end up transplanting one extra patient.

  • Paul Solman:

    Don't make a trade, and one more person goes, or remains, on dialysis.

  • Jairo Acevedo:

    Ok, here goes nothing.

  • Paul Solman:

    Dialysis takes over the job of filtering toxins from the blood. It saves lives, but at a cost — and not just $100,000 annual tab, which is paid by Medicare.

    As dialysis patient Jairo Acevedo told us in a recent story.

  • Jairo Acevedo:

    They say that for every year that you spend in this machine, you lose five years of your life expectancy.

  • Paul Solman:

    And, with no paired exchange partner, he's been on dialysis for seven years, waiting for a deceased donor kidney.

    Rob and Melanie, on the brink of Rob's needing dialysis, are desperate to avoid it.

  • Melanie Melillo:

    We showed up at the transplant center after having Rob's monthly doctor's appointment with his nephrologist and basically said you have to help us. And that's when she said there were other lists, other paired exchange lists to get on.

  • Paul Solman:

    Other lists? The Melillos say they only knew about UNOS.

  • Melanie Melillo:

    You don't know the questions you're supposed to ask if you don't know. We didn't know to ask is this the only list? Are there other lists?

  • Paul Solman:

    Now Westchester does mention other paired exchange programs near the end of an eight-page consent form the hospital says it reviews verbally with all patients before they sign. But the Melillos say it was only when they knew to ask, nearly a year into the process, that Westchester told them about two other major exchanges, neither of which the hospital participates in.

  • Melanie Melillo:

    I understand, you know, it's a business. That's what it is at the end of the day. But his life is in the balance. Our lives are in the balance.

  • Paul Solman:

    The economic point, more exchanges, larger markets, more potential matches.

    And it turns out there's a hospital in New Jersey that participates in all three exchanges, Saint Barnabas Medical Center, with one of the largest kidney transplant programs in the country.

    Nephrologist Shamkant Mulgaonkar.

  • Shamkant Mulgaonkar:

    So we participate in multiple registries and difficult patients. We put them in multiple registries. If you have an incompatible donor in an exchange, the average time is somewhere between six months to a couple of years. So, you will get transplanted as long as you have a living donor.

  • Paul Solman:

    But it sure isn't easy.

  • Marie Morgievich:

    Doing one exchange transplant is significantly more work than doing a donor directly to a recipient that they're compatible with.

  • Paul Solman:

    Again, Saint Barnabas's Marie Morgievich.

  • Marie Morgievich:

    Really 100 people within the hospital at any one time are helping achieve that success.

  • Woman:

    Can you raise your hand if you're a donor? And if you're a recipient?

  • Paul Solman:

    But it's paying off for the members of a Saint Barnabas chain featured on the today show in June — 27 transplants and counting.

  • Melanie Melillo:

    Hi, I'm Melania Melillo.

  • Paul Solman:

    So, the Melillos took their business to Saint Barnabas, hoping they'd found a marketplace big enough for Melanie to give, and for Rob to receive in return.

    And last week, less than a month after this taping, they were told that Saint Barnabas has matched them with another couple where the husband, who needs a kidney, is type A, like Melanie, and the wife, who's willing to give a kidney, is type O like Rob.

    The surgeries may happen by the end of August.

  • Rob Melillo:

    Happy anniversary.

  • Melanie Melillo:

    Happy anniversary.

  • Paul Solman:

    And with the advent of kidney exchange markets, hopefully many more to come.

    This is economics correspondent Paul Solman reporting for the PBS NewsHour.

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