How to Solve the Kidney Transplant Problem

June 18. 2019. 6 mins read

We’ve written a fair amount on using technology to address mental health issues, and during that process we came across a study that said, “depression disproportionately affects those in poverty.” It doesn’t take an MBA to figure out that depression accompanies difficult – and sometimes unexpected – life circumstances. If you suddenly found out you had kidney failure and were now tied to a dialysis machine, you might have an increased likelihood of depression. That’s what happened to one young man living in a faraway place.

It started with flu symptoms but progressively became worse for Juan, an eighteen-year-old boy living in the Marshall Islands. His worried parents flew him to Manila where they discovered he had glomerulonephritis – in short, a disease that diminished his kidney functions. Being a U.S. citizen, Juan was able to receive treatment in Hawaii where his mom comes to visit him in the apartment they had to get because now their son can’t leave Honolulu. All his friends, his college plans, his family, that’s all gone now. Juan can’t leave Hawaii because he’s permanently tied to a dialysis machine – that is, until he receives a kidney transplant. Watching their son grow increasingly depressed, his parents wanted to know what options they had to improve the situation. Let’s talk about kidney transplants first.

Kidney Transplants

The second most searched for term relating to kidney transplants is “Selena Gomez kidney transplant,” which says a lot about where society’s priorities are. Miss Gomez – someone who is idolized for spending most her life pretending to be someone else – apparently underwent a kidney transplant. Again, we see a link here between depression and life’s curve balls.

Selena Gomez gets depressed over kidney problems
Source: Google

Without trying to underplay the difficult life that Justin Bieber’s ex must be leading, we find it far more depressing that of the 121,678 people waiting for lifesaving organ transplants in the U.S., 100,791 await kidney transplants. That’s the latest number from the National Kidney Foundation which says 13 people die every day waiting for a transplant, and 3,000 patients are added to that list every month. Even when a patient receives a transplant, they may end up back on the list. On average, transplanted kidneys last between 10 and 12 years with a 95% success rate. Deceased donors contribute about twice as many kidneys than living donors – which makes sense considering living donors can only donate a single kidney.

A kidney transplant
A kidney transplant – Source: Mayo Foundation

Matching donors with recipients are based on a variety of factors including blood and tissue types, medical need, length of time on the waiting list, and weight of donor and recipient. The median wait time for an individual’s first kidney transplant is 3.6 years. For patients who are waiting, are there any other options to speed up the process?

Human Kidney Substitutes

Our first thought would be to look for substitutes. We’ve talked before about xenotransplantation which involves making pig organs adaptable to humans. A number of companies are working on the problem, and new tools like CRISPR gene editing lead some experts to believe that “in the next decade, xenotransplantation will not anymore be “the future of transplantation” but a successful clinical reality.” When clinical trials start to take place where humans are implanted with pig kidneys, then it’s probably worth taking another look.

An even more moonshot idea is printing kidneys. It’s something that companies like Organovo have been working on for a long time, while other companies like CellLink have emerged with tools that bring us closer to printing organs. Even if we’re able to print a fully functional human organ in the next decade, the process still needs to undergo FDA approval. For a person on that waiting list, xenotransplantation and 3D bioprinting are pretty much pipe dreams.

This brings us to the topic of artificial kidneys. We already have them, and they’re more commonly referred to as dialysis machines.

Artificial Kidneys

People who suffer from kidney failure use what’s called a dialysis machine to replace the function of the kidneys.

What a dialysis machine does
What a dialysis machine does – Source: Fresenius Kidney Care

What you see above would be considered an artificial kidney in that it performs the same functions that a kidney does while patients wait for a transplant. When some people refer to an “artificial kidney,” they’re probably thinking of a device that’s implanted in a person’s body that acts just like a kidney. Unfortunately, no such thing exists. There are various efforts being made to miniaturize artificial kidneys, but none appear to be anywhere near close to market. We need to consider “portability,” and some ideas being proposed just aren’t realistic.

A "portable" dialysis device
A “portable” dialysis device – Source: Medgadget

Researchers are working on the problem though. For example, there’s The Kidney Project which is an implanted bioartificial kidney that uses nanotechnology for filtration. Still, it’s not going to get off the ground without funding for clinical trials which is currently being sought. Other efforts at creating something similar also appear to be very early stage and aren’t backed by commercial interests.

If everyone is looking for a kidney, and there are billions of people on this planet with two functioning kidneys, this is actually something that lends itself well to basic economics.

A Kidney Marketplace

We’re investors who believe in capitalism because we want a return on our investment. We approach problems with this mindset. We’re all about righting the world’s wrongs if there’s an economically viable business model there. That’s how you scale solutions to solve big problems. Building a medical device for 100,000 people would cost a lot of money. If it costs $10 billion to build, we would need to sell it at $100,000 a pop just to break even. Then everyone would piss and moan on social media about how evil we were. Instead, we might propose creating a marketplace for kidneys.

Want to pay off that six-figure debt you incurred studying underwater basket weaving? Sell your kidney to someone in need. Make some cash and have a positive impact on the planet. It’s the perfect solution for America’s student loan debt problem, but the government isn’t having any of that. No governments are, except Iran. That’s the only place on this planet where you can offer up your kidney to someone in need for compensation. A well-cited study on the “Iranian Model of Paid and Regulated Living-Unrelated Kidney Donation” suggests this model ought to be adopted in other countries. Until that time, there’s always bartering.

When starting a business, you often turn to “family and friends” for funding. The same holds true when you’re looking for a fresh kidney. This only works if you have a willing family member donor whose blood type and profile match what’s needed for the patient. When this doesn’t hold true, you can barter. Here’s a diagram that shows how this works.

A Kidney Swap
A Kidney Swap – Source: Johns Hopkins Medicine

The business of bartering for body parts is legal as long as no money changes hands. Around 500 people a year avail themselves of this option, a number which could be considerably higher were it not for market inefficiencies. A paper published a few months ago titled “Market Failure in Kidney Exchange” concludes that “kidney exchange markets suffer from market failures whose remedy would increase transplants by 30%-63%.” Reasons for this include a fragmented and inefficient market where “most transplants are arranged by hospitals instead of national platforms,” and a reward system that doesn’t provide an incentive for hospitals to submit patients and donors.

If you’re someone who wants to do a swap, this means you’ll need to do some research to find the best places to advertise. If you’re looking for a place to start, try Johns Hopkins Medicine. According to their website, “it can take anywhere from one month to two years to find an exchange pair.”


As we alluded to earlier, the kidney transplant problem isn’t getting solved anytime soon because a Total Addressable Market (TAM) of 100,000 people just isn’t that attractive. The most immediate solution to the problem would be simply to deregulate the sale of kidneys – something that in today’s political climate won’t be given much attention. Another option would be to work on improving the ability to match donors who are willing to barter across the globe. There isn’t much of a business model there, but maybe a celebrity who has been affected by the kidney transplant problem could help raise awareness and create such a platform. Juan can only hope.


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