“Another possible solution would be to think about kidney exchange in a global way. There is virtually no kidney transplantation, and little or no access to dialysis, in places such as Nigeria, Bangladesh, and Vietnam, where kidney failure is a death sentence. Presumably, many kidney patients there have willing donors, but in a country such as Nigeria, for example, where fewer than 150 transplants occurred from 2000 to 2010, that willingness doesn’t do patients any good. But suppose we were to offer them access to American hospitals, at no cost? That may sound expensive, but it wouldn’t have to be—indeed, it could be self-financing. Remember that removing an American patient from dialysis saves Medicare a quarter of a million dollars. That’s more than enough to finance two kidney transplants, as well as postsurgical care and medicines. That money could pay for an exchange between an American patient-donor pair and, say, a Nigerian pair.”