Paired Exchanges, Chain Donations, and Organ Markets

This chapter introduces the use of an innovation called “paired exchange,” a way to encourage donations even when there is no match. The chapter shows a graphic presentation to simply describe the idea of paired donation exchange. It explains the risks of paired exchange for the donors' and recipients' perspective, arguing that the risks were the same from the donors' perspective, while the outcomes from the recipients' perspective would be much better as a result of receiving a histocompatible organ than they would be if they received their own designated recipient's organ. The chapter also offers some legal questions after lawyers wondered whether a paired kidney exchange was a sort of barter and thus the beginning of a gray market in organs. Ultimately, the chapter looks at another suggestion of creating a serial chain of donor–recipient pairs, with the world's first kidney–liver swap took place in 2017.