Earlier this month saw the publication of a major investigative piece by the New York Times on what they have described as a large paid kidney donation activity in Herat in Afghanistan. The DICG along with the TTS have written to the hospital authorities to obtain more information on the matter.

There have been several news reports on this story.

Additional Report

Link: https://doi.org/10.1353/hpu.2017.0005  

Author: Kimberly Jacob Arriola

Journal reference: Journal of Health Care for the Poor and Underserved 28 (2017): 30–45.

Summary: This normative article by Jacob Arriola takes two major theories and places them in the practical context of transplantation. The author motivates us to move beyond the documentation of ethnic disparities in transplantation but to get a deeper understanding of why these disparities exist. The role of racism is complex, and prevention or compensation interventions often do not address the problem's multiple and interconnected layers. The paper gives a detailed overview of the manifestation of racism, namely internalized, personally- mediated, and institutionalized racism, and describes how they can be recognized in the different levels of the social ecology of healthcare and transplantation. This paper concludes with clinical, research, and policy recommendations.

To do so, they made use of advanced google searches and interrupted time series analysis methodology. They collected data on “kidney trade,” “kidney sale,” “organ trafficking,” and “transplant tourism” reporting in 25 different countries with time points well before and after the 2008 promulgation of the DoI. They found that the DOI has a positive impact on the reporting of “organ trafficking” and “transplant tourism” but not on the reporting of “kidney sale” and “kidney trade.” They conclude to say that the increased reporting of “kidney sale” and “kidney trade” can be indicative of an impact of DOI on public awareness and increased reporting of the residual transplantation related crimes. 

The authors then provide commentary, seemingly unrelated to the study conducted, and advocate for the legalization of organ trade. While this commentary is in direct conflict with the principles of the DoI, the results ofthe research could still provide valuable insight into the impact of the DoI.

Link: https://onlinelibrary.wiley.com/doi/full/10.1111/ajt.16392 

Author: Reese, P; Mohan, M. et al.

Journal reference: American Journal of Transplantation. 2021;00:1–10.

Summary: Preemptive renal transplantation holds various benefits for patients with end-stage renal disease and should be the aim of all transplant programs. Reese et al. recognized that preemptive renal transplantation practices also give us a clear case presentation to study the effects of systematic racial disparities. Their article provides an excellent description backed up with empirical data of where and why White, better educated, and privately insured patients access the benefits of preemptive transplantation more than other racial groups. They, furthermore, provide an ethical analysis of one of the main exacerbation factors, namely allocation policies based on the first-come-first-serve approach, and propose initiatives to improve this inequity. 

Link: https://doi.org/10.2215/CJN.04860420

Author: Wesselman, H.; Ford, C. G. et al.

Journal reference: Clinical Journal of the American Society of Nephrology. 2021. Vol 16. Issue 2

Summary: In the article by Wesselman et al., the authors pin down the medical and social determinants of health associated with racial disparities in transplantation by prospectively examining 1056 patients referred for renal transplantation. While it is no surprise that their study confirmed the high incidence of renal failure, combined with a lower rate of deceased and living donor transplantation in Black population groups, this study contributes to our nuanced understanding of where inequalities exist. The data provides insights on how to tailor transplant education, deploying media campaigns to increase awareness of transplant options, and support disadvantaged groups through the process of organ donation and transplantation.