Reverse Transplant Tourism

In this article, we propose a novel form of kidney transplantation involving cross-border kidney-paired donation, which we refer to as reverse transplant tourism (RTT). Although RTT is currently still a hypothetical—to date, no RTT swaps have been performed—we argue that such a program, if properly structured, is both legal and ethical and is a natural next step in the development of kidney exchange. Kidney exchanges, in which patients with willing but incompatible living kidney donors exchange their donors’ kidneys, have become common in the United States. RTT takes this approach a step further by redefining incompatibility to include not only immunological barriers, but also a more prevalent incompatibility when transplantation is considered worldwide: the barrier of poverty. In the United States, there are many patients with kidney failure (known as end-stage renal disease (ESRD)) who have insurance to pay for a transplant, but whose donors have the wrong blood type or human leukocyte antigens (HLAs) and thus are not immunologically compatible. In contrast, there are many poor patients outside of the United States with willing compatible living donors, who are not able to afford the immunosuppression necessary to sustain a renal transplant. In both these cases, the patients face