EA - Altruistic kidney donation in the UK: my experience by RichArmitage

Link to original articleWelcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Altruistic kidney donation in the UK: my experience, published by RichArmitage on November 30, 2022 on The Effective Altruism Forum.Last week I donated a kidney as an altruistic donor through the UK Living Kidney Sharing Scheme (UKLKSS). This post will cover the landscape of kidney donation in the UK, how kidneys from living donors are shared in the UK, the process of donating through the UKLKSS, and some reflections on my experience.Note: this post discusses details of altruistic kidney donation specifically in the context of the UK.Kidney donation in the UKAt any one time, some 3,500-5,000 patients with end-stage renal disease (ESRD) sit on the UK’s national waiting list in need of a kidney donation. While most of these are adults, 112 children (under 18 years of age) were in need of a replacement kidney in April 2021 (most recent data available). While waiting for a replacement kidney, these individuals must undergo renal dialysis for three to four hours per session, three times every week, which imposes severe limitations on the freedom in their lives and their ability to enjoy a ‘normal’ existence. Around 250 of these people die every year, either because a suitable donor cannot be identified in time, or after they are removed from the waiting list due to a deterioration in their health that renders them no longer able to endure the necessary surgery and immunosuppressive therapies inherent to organ transplantation.Around 3,000 kidney donations take place in the UK each year, of which about 2,000 originate from deceased donors (an opt-out system of organ donation after death came into effect in Wales in 2015, in England in 2020, and in Scotland in 2021, and Northern Ireland will follow suit in 2023), and about 1,000 from living donors. Kidneys constitute by far the most frequently donated solid organ in the UK (67.6% of all solid organ donations in 2019/20), followed by liver lobes (which can also be donated by living donors), and heart, lungs and pancreas (which obviously cannot).How are kidneys from living donors shared in the UK?Kidneys donated from living donors are ‘shared’ across the UK through the UKLKSS, which includes paired/pooled donations (PPD), and altruistic donor chains (ADCs) that are initiated by non-directed altruistic donors (NDADs).A person in need of a kidney (the recipient) may have a specific individual (such as a family member, partner or close friend) who is prepared to donate one to them (the donor), but is unable to do so directly since this donor-recipient pair is incompatible by Human Leucocyte Antigen (HLA) type or ABO blood group. Such incompatible linked donor-recipient pairs are registered in the UKLKSS and ‘matched,’ through quarterly Living Donor Kidney Matching Runs (LDKMR), with other incompatible linked donor-recipient pairs that, in some combination, are together compatible for donation exchanges.In PPDs, a two-way (in paired donation) exchange occurs between two linked pairs (D1-R1 and D2-R2) in which D1 donates to R2, and D2 donates to R1, while a three- or greater-way (in pooled donation) exchange occurs between more than two linked pairs in which (for example) D1 donates to R2, D2 donates to R3, and D3 donates to R1.Individuals not in linked pairs but who wish to donate a kidney without the promise of a linked recipient receiving one in return can do so anonymously as NDADs. Such donors are registered into the UKLKSS and donate to a recipient in the paired/pooled scheme, triggering an ADC consisting of multiple donations (NDAD donates to R1, D1 donates to R2, D2 donates to D3, and so on) that culminates (when no compatible linked pairs remain) in the last donor donating to a recipient on the national waiting list. The first non-directed altruistic kidney donation in the UK took place in 2006 and, since the beg...