Howard Broadman and his grandson. Image: UCLA Health

For many people, life on the organ transplant list is a death sentence. The numbers just don’t add up. Right now, there are 75,421 active candidates on the wait list. So far this year, there have been 10,869 organ donations. Many of the people on that wait list will die.

In hopes of making that math a little less grim, in 2014 a former California judge named Howard Broadman conceptualized an interesting approach to getting more healthy people to voluntarily donate kidneys. His 4-year-old grandson had a chronic kidney disease that meant he was likely to need a transplant later in life, but by that time Broadman surmised he would likely be too old to donate his own kidneys. So instead, he envisioned a sort of pay-it-forward system for kidney donation: He would donate his own healthy kidney to a stranger, and in return receive a voucher he could give to his grandson that would put him at the top of the transplant list.

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Broadman got UCLA to agree to the idea, and he became the first participant in the school’s transplant voucher program. Eventually, other hospitals adopted the program. Now, the surgeon who completed Broadman’s transplant, UCLA’s Jeffrey Veale, reports in a new study in the journal Transplantion that the scheme has been successful in spurring kidney donation.

The study looks at just the first three voucher cases, including Broadman’s. But it found that those three voucher donations triggered a chain of donations that ultimately resulted in 25 transplants.

In total, the US National Kidney Registry has so far issued 21 kidney vouchers at 30 different hospitals, triggering donation chains that have led to 68 transplants.

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“Vouchers remove a disincentive to kidney donation, namely, a reluctance to donate now lest one’s family member should need a transplant in the future,” Veale and his coauthors wrote.

A previous study had found that more than a third of people who need a transplant are unable to accept a kidney from a friend or family member who is willing to donate because of biological incompatibility. The new study concludes that the voucher system may also increase the number of living donor transplants by inspiring those “chronologically incompatible” with their organ recipient of choice to still donate. In other words, people who are not compatible with their loved ones in need of organs may wind up becoming donors anyway.

The voucher system has gained the approval of the National Kidney Registry’s medical board, and is now offered in 30 hospitals. Maybe one day we will be able to just grow new organs in a lab. In the meantime, while these early results are preliminary, it seems vouchers are already chipping away at those many names on the transplant list.