KIE symposium leads to first reverse tourist kidney transplant

RRT-Donor-Chain.-400A young family in the Philipines gained a new lease on life due to a partnership between a Duke Law professor, a Canadian doctor, and the Nobel Prize winner who connected them. Jose Mamaril recently became the first recipient of a kidney through “reverse transplant tourism,” a way to combine complex donor chains in the United States with patients in developing countries.

This cross-border donation system began as an idea brought by Dr. Michael Rees, a transplant surgeon at University of Toledo Medical Center, to an interdisciplinary conference funded by the Kenan Institute for Ethics at Duke, organized by Kim Krawiec, Kathrine Robinson Everett Professor of Law and Philip Cook, Professor of Public Policy, Economics and Sociology.

The conference attracted scholars in medicine, law, economics, sociology, and philosophy, including Alvin Roth, a Nobel Prize winning economist with experience in organ donation patient matching systems. It was Roth that connected Rees with Krawiec. Of the partnership, Krawiec says “innovation in transplantation raises a lot of legal issues. I was interested in many of the same questions Mike was exploring — why is exchanging a kidney for a kidney an acceptable trade while trading a kidney for money is not?”

Organ donation allows those with kidney failure to avoid the costly and cumbersome process of continued dialysis. Altruistic donor chains allow willing donors to be paired with recipients of matching blood types. Many times a patient may have a spouse or family member willing to donate, but are incompatible with their loved ones. Rees performed the first extended, altruistic donor chain in 2006.


Together, Krawiec and Rees tackled the issue of reverse tourism, publishing an article that puts the pieces in place to take the idea into practice. On January 6, Rees performed the first procedure of this type, bringing Jose Mamaril to Ohio to receive a new kidney. This required both $150,000 in private donations for travel and medical costs and a well-organized donation chain. Mamaril’s kidney transplant came from a donor in Georgia; in exchange, his wife Kristine Mamaril donated her kidney to a recipient in Minnesota, who had an incompatible willing donor. The kidney from this willing donor was then sent to a recipient in Seattle.

Krawiec is optimistic of the way in which reverse tourism transplants will be able to transform lives. “It’s really rewarding to see one of your academic papers translated into a real world practice. We’re hopeful that this innovation will make a difference, not only in the lives of poor patients around the world, but for those in the U.S. who have waited years for a transplant due to the lack of a compatible donor.”

She warns, however, that the opportunities available through reverse transplant tourism cannot rely on philanthropy alone. “We need the insurance companies and Medicare – who save tens of thousands of dollars from each reverse tourism transplant – to fund this and other transplant innovations in order to really make a dent in the ever-growing wait list.”