by George Taniwaki

A new organ preservation method may help increase the number of transplants. It could dramatically increase the survival of patients with end stage liver or heart disease.

Background

The most common organ to be transplanted are kidneys. Part of the reason is that there are lots of patients with kidney failure waiting for a transplant. And part of the reason for that is patients with kidney failure can be placed on dialysis therapy while waiting for a donor organ. This allows them to survive several years while waiting for a donor organ. Patients requiring a replacement for failed hearts, lungs, and livers cannot wait. They must be transplanted quickly. If an organ is not available, they will die.

The other reason kidneys are the most common organ to be transplanted is that donor kidneys can be kept in ice water storage for 24 to 36 hours prior to transplant and still remain viable. This provides time to run crossmatch tests using blood samples from the donor and several possible recipients, contact the best matching patients and their surgeons, get them to the hospital, and transport the donor organ to the hospital. Hearts can only be stored about 4 hours and livers can only be stored about 12 hours. This often is not enough time to prepare for surgery and so the donor organ has to be discarded, unused.

I discuss some of these issues in earlier blog posts. For instance, see my Nov 2010 blog entry and May 2010 blog entry.

New and supercool protocol

In a paper published in Nature Medicine, Jun 2014 (subscription required), Tim Berendsen at University Medical Center in Utrecht, the Netherlands, Bote Bruinsma at Massachusetts General Hospital and Harvard Medical School, and others have developed a new protocol to supercool organs below zero (32 deg F) without freezing them. Their technique was tested on rat livers, but would likely work on human livers and would work with other organs, including kidneys. A good explanation of the process is included in a Jun 2014 press release.

HarvardRatLiver

Figure 1. Supercooled rat liver being perfused with new solution developed by Harvard researchers. Photo from Harvard University

Their technique involves four steps. First, the organ is placed in a vessel while an ice cold solution (usu. about 4 deg C, 39 deg F) is circulated through it, a process called perfusion. The solution contains dissolved oxygen and nutrients such as glucose that help keep the organ alive. This is already the standard procedure for perfusing organs.

What is new, is the perfusion solution and the next steps. The perfusion solution contains PEG-35kD (polyethylene glycol) and other proprietary ingredients (to be commercialized) that act as an antifreeze. This allows the solution and the liver to be carefully cooled to -6 deg C (21 deg F) in a way that avoids the formation of ice crystals that could damage the cells in the liver. The liver can remain perfused in the supercooled condition for up three days and remain viable. Then the liver is carefully warmed to above freezing and prepared for surgery as normal.

HarvardRatLiverChart

Figure 2. Chart showing temperature profile of liver using proprietary perfusion solution and supercooling protocol. Image from Nature Medicine

Extending the viable time for liver transplant from 12 hours to three days would be a huge change. It would allow many more transplants to occur, with a corresponding decrease in the number of patient deaths caused by a shortage of organs. Just as important, by allowing time for multiple crossmatch tests to be conducted, it could potentially improve the matching of organs to patients.

The next steps in the research is to try livers from larger animals and to test the protocol on other organs.

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by George Taniwaki

I recently received two comments on this blog from what appear to be scam artists seeking to prey on desperate people who might be persuaded to buy or sell a kidney.

I didn’t bother to follow up with either person to learn more about this scam. I say scam because it is illegal to buy or sell organs in nearly every country on earth. Further, nobody will pay for your travel expenses to a developing nation to have a nephrectomy (kidney removal surgery).

Bottom line: Do not respond to messages from strangers offering you money!

The messages

The first message shown below, is short and specifically is targeted at poor people who need money.

Do you want to sell your kidney due to financial problem? If yes you are in the right place of selling your kidney for good money. contact us @ SAWAN NEELU ANGEL’s HOSPITAL Multi specialist Home, J-293,Saket, New Delhi-17 India.. Email Us now:

Very Urgent

 

Dr Ashok kumar
ASN Directo

 

The second message is a bit of a mixed bag. This scam artist starts his pitch with an offer to help poor people desperate for a chance to escape debt. But at the end of his message, makes a stab at conning kidney patients to make a down payment for a transplant.

Good day,

Do you want to buy a Kidney or you want to sell your kidney? Are you seeking for an opportunity to sell your kidney for money due to financial break down and you don’t know what to do, then contact us today and we shall offer you good amount for your Kidney. My name is Doctor Calvin Cien am a Nephrologist in UBTH clinic hospital. Our clinic is specialized in Kidney Surgery and we also deal with buying and transplantation of kidneys with a living an corresponding donor. We are located in Indian, Turkey, Nigeria, USA, Malaysia. If you are interested in selling or buying kidney’s please don’t hesitate to contact us via email.

Best Regards.
Dr. Calvin Cien.

 

For more on how comment spam is created, see this blog post:

Comment spam template (June 2014)

For more on how scams work, see the following blog posts:

The Craigslist counterfeit check scam (June 2013)

Paris scam artists (March 2011)

by George Taniwaki

The human cytomegalovirus (CMV), a member of the Herpesvirus genus, is highly contagious and quite widespread. It is estimated that over two-thirds of all adults have anti-CMV antibodies in their blood and the proportion of the population exposed increases with age.

CMV infection is usually quite mild. Most people who have it don’t even know it. However, it can cause serious illness and death to those who are immunocompromised such as infants, the elderly, patients with HIV infection, and patients who have received a bone marrow or organ transplant. An excellent primer on CMV and its impact on kidney transplants in provided in the J. Amer. Soc. Nephr. Apr 2001.

Because CMV is so common, it is impossible (both mathematically and ethically) to avoid using donor kidneys that are infected, even when transplanting into a patient who tests negative for CMV antibodies.

As can be seen in the table below, the infection risk is lower for patients who test negative for CMV antibodies (possibly because they have a natural immunity to the virus). It is also lower for patients who receive a kidney from a donor who tests negative (since the kidney is less likely to carry the virus). The percentages in each group assumes random distribution of CMV among donor and patient populations.

Level of risk and (% of population) Patient CMV-
Lower risk  (33%)
Patient CMV+
Higher risk (67%)
Donor CMV-
Lower risk (33%)
Lowest risk (11%) Low risk (22%)
Donor CMV+
Higher risk (67%)
High risk (22%) Highest risk (45%)

 

For solid organ transplant recipients, CMV is the most common serious viral infection. Medscape notes that, “CMV infection usually develops during the first few months after transplantation and is associated with clinical infectious disease (e.g., fever, pneumonia, GI ulcers, hepatitis) and acute and/or chronic graft injury and dysfunction.”

The standard procedure to prevent or treat CMV infection is to prescribe ganciclovir, sold under the trade names Cytovene and Cymevene (Roche). Like other antiviral drugs, ganciclovir disrupts the replication of viral DNA.

Unfortunately, this drug has several limitations. First, widespread use of the drug seems to be leading to increased incidence of ganciclovir-resistant CMV infection. Second, the drug can cause serious side effects including hematological (blood) effects such as granulocytopenia (low white blood count), neutropenia (low neutrophil count), anemia (low red blood count), and thrombocytopenia (low platelet count). Third, animal studies showed it to be a potential human carcinogen, teratogen, and mutagen.

image

Figure 1. Replication of long chain of viral DNA by CMV. Image from New Engl. J. Med.

New therapy option

A new drug to prevent or treat CMV called letermovir is currently under investigation. In the New Engl J. Med. May 2014 (subscription required), Roy Chemaly and his coauthors report that among patients receiving hematopoietic stem-cell transplants (bone marrow transplants), use of letermovir significantly reduced the incidence of CMV infection and the level of viral DNA fell as the dose increased. This means the new drug is quite effective. Just as important, it had an acceptable safety profile. Patient taking even the highest dosage  did not report greater side effects than those taking the placebo. Specifically, it showed no hematologic toxicity or nephrotoxicity (kidney damage). An excellent discussion of this breakthrough is provided in an accompanying editorial that appears in the same issue. The editorial also highlights the higher reliability and sensitivity of quantitative polymerase chain reaction (PCR) to measure viral load and predict the onset of symptoms.

Naturally, additional studies will need to be conducted to test letermovir with patients receiving a solid organ transplant. But the initial test results are promising and give hope that within this decade fewer kidney transplant patients will lose their graft or their life due to CMV infection.

by George Taniwaki

Remember, World Kidney Day 2014 is coming soon. This year it is 13 Mar 2014 and the theme is “kidneys age, just like you.” This campaign, designed to raise awareness of kidney health is organized by the International Federation of Kidney Foundations and the International Society of Nephrologists and is sponsored by Danone Research.

If you are interested in generating publicity, see the flyer below. To get a copy of the promotional materials, click here.

  World Kidney Day
Get ready for 13 March 2014
Kidneys age, just like you
 
 
   
 
 

Happy 2014!
May you all have a wonderful year ahead, full of joy and happiness. We look forward to an exciting 2014 and a tremendous World Kidney Day!

 
 
SEE ALL OUR MATERIAL!
 
 
 
To kick-start the new year, we are happy to share with you our brand new campaign material! Click here to see it all. In these last months leading up to World Kidney Day, we will continue to make more material available.
 
You are free to use and share all this material with your colleagues, friends and relatives. All items are available in editable format so you can translate them to your local language before using them.
The success of World Kidney Day depends on you. Help us create a buzz about World Kidney Day and distribute this material as much as you can. Also, don’t forget to share your plans with us by pinning your events and initiatives on the
interactive map.
 
 
Click on the icons below to join our social media community. This is where we our WKD family is built. You can share your ideas, pictures and get regular updates on the campaign status, and more.
fb t yt g+  
Click on the icons to access our pages…
 
World Kidney Day is a joint  ISNIFKF   initiative supported by   DANONE RESEARCH
 
 

 

by George Taniwaki

This month the University of Washington Medical Center (UWMC) has been highlighting its transplant program. Using a combination of traditional and social media, UW Medicine publicized its success with some great stories about its transplant patients and donors.

The first story celebrates UWMC’s 6,000th solid organ transplant. The milestone was achieved by Dr. Stephen Rayhill, a surgeon in the kidney transplant program. The patient is Frannie McLaughlin, who received a kidney from her daughter, Kiki McLaughlin-Cook (Yakima Herald Nov 2013). The surgeon and donor are featured on UW Medicine’s Facebook page, in the post reproduced below.

UWMC_KikiTx

Incidentally, Dr. Rayhill was the surgeon who transplanted the kidney I donated. (He was not the surgeon who removed my kidney though, that was Dr. Ramasamy Bakthavatsalam.)

Next up is post featuring heart transplant patient Cindy Kehl, who this year is celebrating 20 additional years of life.

UWMC_6000thTx

Next is a post featuring Ameen Tabatabai, who after receiving a new liver is now healthy enough to attend UW and is training with Team Transplant, a running group at UW Medicine.

UWMC_AmeenTx

Next are Brad Bonn and Ken Price. Brad is a recent lung transplant recipient while Ken became the first listed double lung transplant recipient at UW Medicine 20 years ago (KOMO News Jul 2013).

UWMC_BradTx

UWMC_KenTx

Finally, on January 14, UW Medicine performed its first Live-Tweet of a kidney transplant surgery. The surgeon was Stephen Rayhill and the patient was Dave Skelton, a patient at Northwest Kidney Centers. (A Live-Tweet is a technique where a participant in an event provides pictures and commentary in real-time to an audience using Twitter. If you are not a Twitter user, it’s a bit hard to explain.)

Dave’s wife, Brittany, was willing to donate a kidney to him, but was not a biological match. The two asked UWMC to enter them into a kidney exchange to find a match. (UWMC is a member of the National Kidney Registry.) The NKC was able to find a match and Dave became the second patient in a chain. His new kidney came from a donor in South Carolina. Two days later, Brittany underwent her donor surgery and her kidney was sent to a recipient in Missouri.

This is a long chain involving twelve donor-patient pairs (24 surgeries total). “Being part of the 12-way swap is very exciting and humbling. It is amazing the selfless commitment the donors are displaying. People are amazing and have rekindled my faith in humanity,” says Dave. For more about kidney exchanges see this Mar 2010 blog post.

To see the original tweets, search Twitter for @UWMedicineNews #UWMedicineKidney. To see the summarized tweets, go to Storify, sfy.co/dYLB.

UWMC_StorifyDaveTx

To see the slideshow version go to Storify slide show.

image

by George Taniwaki

There is an ongoing argument regarding whether we as a society should pay people to donate a kidney. These arguments, both pro and con, revolve around two issues, whether such payments are the right thing to do (ethics) and whether they would increase the number of available organs (economics). This blog post will describe the economic effects of payments.

Organized markets

Before analyzing the effect of payments on the supply of donors, I want to assure readers that payments can be regulated. For instance, nearly all the blood, plasma, and platelets in the U.S. is collected from unpaid donors. Yet at the same time, there is also an active government regulated market for plasma. Similarly, family members and friends are a common source of donor eggs, donor sperm, and surrogates to allow individuals to have a child. But there is an active market for these as well.

An organized market for donor organs would not likely include person-to-person transactions. Rather, it would involve highly regulated, non-profit entities that would act as intermediaries between donors and patients, similar to the existing network of organ procurement organization (OPO) that recover and distribute organs from deceased donors. In other words, ignore the image in Figure 1.

kidney_for_sale_tshirt

Figure 1. Kidney for Sale t-shirt. Image from zazzle.com

One of the arguments against paying donors for organs is that it will favor wealthy patients who can afford the price. That is not necessarily so. Laws can still be written to prohibit individuals or hospitals from making payments to donors. The payments can be regulated to only allow insurance companies and other government sanctioned groups to make payments. Similarly, the organs collected from donors need not be transplanted to patients based on ability to pay for the organ. They can be allocated by whatever method is deemed medically and ethically justified.

More patients could benefit from transplants

Many kidney disease researchers, ethicists, and economist agree that under the right circumstances, increasing transplant rates would be a good thing. First, transplants improve medical outcomes. Second, transplants save money.

Studies have shown that patients with end-stage renal disease (ESRD) who receive transplant therapy live longer than those who receive dialysis therapy (U.S. Renal Data System 2013 Report). This is true even after adjusting for the fact that transplant patients are healthier on average than the overall kidney patient population (R. Wolfe, et al., New Engl J Med Dec 1999).

The data also shows patients who receive transplant therapy report a better quality of life than those who receive dialysis therapy (W. Fiebiger, et al., Health and Qual Life Outcomes Feb 2004).

More transplants would save money

In addition to being better for the patient, transplants can save money. Dialysis therapy costs about $75,000 per year per patient. Transplant therapy costs about $150,000 for the first year (evaluation, surgery, recovery, and follow-up) and then $15,000 per year thereafter (antirejection medication, infection control, and monitoring). Over the lifetime of the graft, a living unrelated donor can save society $94,000 compared to dialysis (A.J. Matas and M. Schnitzler Amer J Transpl Feb 2004). Adding the value of the additional 3.5 quality-adjusted life years for the patient increases the social benefit to $269,000.

A recent paper by B. Manns et al. (Clin J Amer Soc Nephr Dec 2013) indicates that even a 5% increase in the number of donors would justify a payment of $10,000 each by providing an incremental cost-savings of $340 and a gain of 0.11 quality-adjusted life years.

There is a shortage of suitable organs

The reasons more kidney patients don’t pursue and receive transplant therapy are not fully understood. One thing is certain though. The number of viable organs that become available each year is significantly lower than the number of patients newly diagnosed with ESRD. Thus, the expected wait time for a transplant continues to get longer (up to 8 years in California).

About 15% of patients on the waiting list die each year, so the proportion of patients who die without ever getting a transplant increases as the wait gets longer (over 50% in California). This long wait may deter some patients (and their doctors) from even starting the transplant evaluation process. As of this writing, there are 98,935 people in the U.S. waiting for a kidney transplant.

According to the U.S. Renal Data System, there were 115,643 people newly diagnosed with ERSD in 2011, the latest year data is available. This includes 2,855 who received a preemptive transplant (meaning they received a transplant before having to go on dialysis). In contrast, the  Organ Procurement and Transplantation Network (OPTN), shows there were only 16,814 transplants performed in the U.S. in 2011. The breakdown by donor type is shown in the table below.

Living directed donor   3,761
Living exchange donor       575
Living nondirected donor       157
Deceased directed donor       123*
Deceased nondirected donor 12,198
Total 16,814

*Assumes that 1% of deceased donor transplants are directed (OPTN 2009)

Of the total, 3,761 came from living directed donors, meaning the donor and the recipient knew each other. 575 came from exchange donors, meaning the donor knew the intended recipient but was incompatible so donated to a stranger who was in the same position and they swapped kidneys (for details see Mar 2010 blog post).  157 came from living anonymous or nondirected donors, meaning the donor did not have an intended recipient (similar to most blood donations). Finally, 12,321 came from deceased donors (of which all but about 123 are nondirected).

Costs to becoming a live kidney donor are high

For now, we will ignore the impact of paying for deceased donor organs and focus on a possible market for live donors. Further, we will ignore the ethics and legality of paying people to become live kidney donors. We will cover these issues in a future blog post. For now, we will explore the economics of paying for live donors.

Being a living donor can be expensive. The evaluation and surgery are paid for by the recipient’s insurance. However, there are lots of out-of-pocket costs such as travel to and from the transplant hospital for evaluation. In some cases, there can be multiple trips and may require a hotel stay for out-of-town donors. There are also opportunity costs, such as lost wages (or foregone billings for the self-employed) for the time spent in evaluation, surgery, and recovery. The time spent at home after surgery can vary from a few days to over a month, so this is a real burden for people who don’t receive sick pay or disability insurance from an employer. I estimate the total out-of-pocket and opportunity costs for a typical donor to be about $2000.

Usually, all of these costs are borne by the donor, meaning most donors are wealthy. Sometimes, the recipient will pick up some of these costs, especially if they are wealthy. Sometimes the donor and recipient conduct a fund-raiser to pay these costs. Finally, there are several charities that provide reimbursement if the donor or the recipient cannot afford the financial burden of paying for a living donor transplant. The best known of these is the National Living Donor Assistance Center.

Supply curves for nonaltruistic, nondirected donors

To analyze the effect of payments for kidney donors, we will use the basic technique used by economists called a supply curve. The supply curve shows the quantity (Q) of organs supplied for any price (P). We will look at the impact of paying for kidneys on three groups of living donors.

The first group is the nonaltruistic, nondirected (NAND) donors. This consists of the population of people who are aware of the existence of people who need a kidney transplant but don’t know anyone personally who needs a kidney. Further, they may be willing to donate a kidney, but have no desire to donate a kidney for altruistic reasons.

Figure 2 shows a hypothetical supply curve for kidneys from this population. At the current offering price today (Pcur), the quantity of kidneys offered by NAND donors is zero. Note that Pcur is negative and reflects the costs associated with  being a donor.

Raising the offer price will not result in any donors appearing until an offer of PNANDmin is made and the first donor will step forward. This initial price may be quite high due to what is called the repugnance factor by economist Alvin Roth (J Econ Perspectives, Summer 2007). (Repugnance will be discussed again when we explore the moral and legal issues surrounding payments to donors.)

As the price rises, more donors appear. However, at some point there may be some proportion of these potential donors who will be very reluctant to volunteer, regardless of the amount of money offered (perhaps because of very high repugnance, fear, or dislike of pain). At this point the supply curve will rise steeply, until you reach the last person in the population (QNANDmax) where a very large sum of money must be offered before they will be willing to undergo kidney donor surgery.

DonorSupplyNAND

Figure 2. Supply curve for nonaltruistic, nondirected donors

Note that I made a simplification in the supply curves shown above and below. I assume the out-of-pocket costs and opportunity costs for all donors is the same and equal to Pcur. Actually, this is not true and these costs can vary widely. However, allowing for varying costs makes the analysis much more complex without adding any new insights.

As an aside, behavioral research shows that people’s preferences are not stable, called the endowment effect. For instance, many people may say they would not donate a kidney for $20,000. But imagine what would happen if we gave those people the $20,000 first and ask them to consider what they could do with that money. Then we wait a few minutes and ask them if they would rather give the money back or donate a kidney. At that point, many may decide donating the kidney is their preferred choice.

Supply curve for directed donors

The second group we want to look at is potential directed donors. These are people who know someone who needs a kidney transplant and may be willing to donate to that person. The reasons may be altruistic, self-interest (not wanting to lose a relative or friend), or perhaps even coercion by the recipient or family members. Regardless of the reason, we can draw a supply curve like the one shown in Figure 3.

This curve looks very similar to the one in Figure 2 except it is shifted down. That is, once a potential donor develops a connection to the recipient, the minimum reservation price drops. That’s because the act of donation generates utility for the donor. At the current price of Pcur there are QDDcur donors.

DonorSupplyDD

Figure 3. Supply curve for directed donors

Raising the price offered to this group should increase supply, even if the offered price is below PNANDmin. Just reimbursing every donor’s out-of-pocket and opportunity costs could have a significant impact on supply. However, the supply is limited to QDDmax based on the total number of people who know someone who needs a transplant.

Supply curve for altruistic nondirected donors

The third group we want to look at is altruistic nondirected (AND) donors. Even though these donors do not know the recipient, and in fact often will never know the recipient, the supply curve for this group looks very similar to that of the directed donors. The utility an AND donor derives from her donation is not from helping a known person. Perhaps, it comes from imagining that the donation is helping a deserving person, or helping society as a whole, or the donation represents an act of altruistic sacrifice. At the current price of Pcur there are QANDcur donors.

Similar to the case for directed donors, just reimbursing every donor’s out-of-pocket and opportunity costs could have a significant impact on supply. Offering a payment (which a truly altruistic donor could decline and donate to charity) may increase the supply as well. However, it is not likely to have a large effect. I suspect the supply of altruistic donors is inelastic. I also believe the total number of people who would be willing to donate to a stranger QANDmax is limited as well, though probably significantly larger than the current 150 per year.

DonorSupplyAND

Figure 4. Supply curve for altruistic, nondirected donors

Shifting the supply curve

There is an alternative response to raising the offering price to AND donors. Since the utility the AND donor receives is dependent on psychological reward, any action that reduces the value of that reward may shift the supply curve upward. At the limit, the AND donors will become a NAND donors. In the worst case, the former AND donors may have a higher reservation price than the NAND donors causing the supply curve to be above the curve for the NAND donors (dashed brown curve S’ in Figure 4).

If this supply curve shift occurs, then paying donors could have the perverse effect of reducing the total number of donors until price PNANDmin is exceeded and NAND donors begin to appear.

Conversely, a well-crafted marketing effort to encourage more people to become AND donors can keep the AND curve from shifting upwards. It can also convince some NAND donors to reconsider their position and become AND donors, causing the total number of NAND donors to shrink and the number of AND donors to rise (shifting QNANDmax to the left and QANDmax to the right).

Add it all up

Combining the three supply curves would create an overall supply curve that would look similar to the solid line in Figure 5. At the current price Pcur, the number of donors is QDD+ANDcur. When the price reaches PNANDmin, the NAND donors will begin to enter the market.

If making payments causes all the AND donors to become NAND donors, then the supply curve shifts to upward as shown by the dashed line S’.  At the current price Pcur, the number of donors falls to QDDcur. When the price reaches PNANDmin, the NAND donors will begin to enter the market. When the price reaches P’ANDmin, the former AND donors will enter the market. Note that even if all the AND donors become NAND donors, there will still be a market price somewhere above PNANDmin that will result in more donors than are currently available at the current price of Pcur.

DonorSupplyTOT

Figure 5. Cumulative supply curve for all donors

More resources

For more on the economic analysis of organ markets, see the following papers.

A. Tabarrok. Library Econ Liberty, Aug 2009. Discusses payment for deceased donor organs.

Scott Halpern, et al. Annals of Int Med, Mar 2010. 342 participants were asked whether they would donate a kidney with varying payments of $0, $10,000 and $100,000. The possibility of payments nearly doubled the number of participants in the study who said they would donate a kidney to a stranger. Payment did not influence those with low income levels more than those with high incomes.

Gary Becker and J.J. Elias. J. Econ Perspectives, Summer 2007. A thorough analysis of the cost and number of transplant performed if payments were allowed for the donation of both live and deceased donor kidneys. It also counters the arguments against payments.

by George Taniwaki

Once you and your kidney matchmaker have mailed letters to all of your friends, relatives, and others on your mailing list, consider broadcasting your message to an expanding circle to include coworkers, church members, neighbors, and others in your social network who you don’t know as well. One or more of them may be willing to begin the donor evaluation process. But until you tell them, they are unlikely to know of your need for a kidney donor. And if they don’t know, they won’t get tested.

One of the best way to reach these folks is a flyer (Fig 1) posted on a message board where they can see it.

FlyerSandra

Figure 1. Example of a half-page flyer. Courtesy of Sandra Driscoll

Design a flyer

A flyer can be almost any size from business card (2” x 3-1/2”) to poster (24” x 36” or more). For convenience, I recommend making it 8-1/2” x 11” (or A4 size in Europe) with vertical (portrait) orientation. A good flyer is like an advertisement. It must catch a person’s attention and make them want to stop and read it. Like an advertisement it should have the contain the following elements:

  1. Headline
  2. Photograph or illustration
  3. Message to potential donors
  4. Your contact information
  5. Logo (optional)
  6. QR code (optional)
  7. Tear-off tabs (optional)
  8. Calling card holder (optional)

Tips for creating a flyer are available at the Living Kidney Donor Search (LKDS) website

Items 1 through 5 (Headline to Logo)

Advice for creating a headline, photograph or illustration, message to potential donors, your contact information, and logo are provided in a separate Nov 2013 blog post.

The advice in that blog post was specifically targeted toward the design of a calling card, which is generally much smaller than a flyer. Just because a flyer has more space available doesn’t mean you need to fill it all with text. Having abundant white space makes the flyer attractive and can guide the eye to the important information. Use the extra space to make the headline bigger, make the picture bigger, and add more white space around your message to potential donors. Resist the temptation to add more text and make your story more detailed. Instead keep it the same as your calling card. Or, if you do add more text, do it to make your story more persuasive in order to drive people to your website or take other action.

Add a QR code to your flyer

A QR code is a 2-dimensional bar code (Fig 2). Anyone who owns a smartphone with a built-in camera and a bar code reading app can scan the bar code and be directed to a website with more information.

If you have a personal website or Facebook page with information about your need for a kidney donor, you should add a QR code to your flyer. You can do this by going to http://delivr.com/. This free service will create a bar code for you. Further, every time someone scans your bar code, it will track it and provide you with statistics about the users.

For instance, I created an account on delivr.com. I created a new campaign and entered the address for my patient guide, https://realnumeracy.wordpress.com/kidney-patient-guide/. The delivr.com service creates a custom link for me delivr.com/2tpt6 and generates the QR code that I can include anywhere (Fig 2).

FlyerQRcode

Figure 2. QR code that directs readers to delivr.com/2tpt6 and redirects to realnumeracy.wordpress.com/kidney-patient-guide

An example of a flyer with a QR code is shown below (Fig 3). One suggestion to improve this flyer. I would include the web address in the flyer. That way, people without a smartphone can still visit the website by writing down the address and visiting it once they get home.

FlyerTarra

Figure 3. Example of a flyer with QR code. Image from Shining Strong for Tarra

Add tear-off tabs to your flyer

To engage people who don’t have a smartphone, you can add tear-off tabs to the bottom of your flyer. The tear-off tab should include your phone number and website address (Fig 4). A little trick to make people more likely to tear off one of the tabs is to tear the first one off yourself before posting the flyer.

Also remember to include all the contact information in the body of the flyer so that people can copy it down in case all the tabs are taken.

FlyerEric

Figure 4. Example of a flyer with tear-off tabs. Image from KidneyQuest.com

Add a calling card holder to your flyer

Even better than tear-off tabs is folding the bottom of the flyer to create a pocket to hold your calling cards (Fig 5). Encourage people to take one. Again, remember to include all the contact information in the body of the flyer so that people can copy it down in case all the calling cards are taken.

FlyerCallingCardHolder

Figure 5. Example of a flyer with calling card holder

Printing and distributing your flyers

The least expensive way to print your flyers is to use a home inkjet printer. If you don’t have one, you may be able to have your matchmaker or another friend print them for you. Otherwise, you can have them printed at a local print shop. For great tips on choosing paper and printing flyers check out the LKDS website.

Places that often have a bulletin board where you can post your flyer include:

  1. The print shop where you bought your flyer
  2. Grocery stores
  3. Your workplace or union hall and those of all your friends and family members
  4. Local shopping malls/strip malls
  5. Churches

Remember to get permission from the owner of the bulletin board before posting your flyer.

To make it easy for your friends and family to print their own flyers, make sure a copy of it is posted on your website.

For more ideas on finding a donor, see my Kidney patient guide.