Founder’s Registry Revolutionized Kidney Swaps — and Sparked Financial and Ethical Questions

The National Kidney Registry, created in 2007 to speed paired kidney donations, has enabled nearly 12,000 swaps and shortened wait times for many recipients. Its founder, Garet Hil, built the program around proprietary matching software and nationwide logistics that many hospitals value.

At the same time, the registry has become a lucrative operation with limited public oversight. About 40 percent of U.S. transplant centers work with N.K.R., which charges hospitals subscription and per-transplant fees that have risen sharply — some contracts reviewed show annual fees climbing from roughly $2,500 in 2011 to about $30,000 today, and additional testing, travel and logistics costs that can push totals past $60,000 per transplant.

From 2012 through 2023, N.K.R. paid at least $39 million to Hil & Co., a technology company owned by Mr. Hil, charity filings show. In 2023 the registry transferred commercial operations to Best Match Corporation, a for-profit company owned by Mr. Hil; that year N.K.R. reported $69 million in revenue and paid $8.2 million to Hil & Co., and Best Match bought the commercial arm for $2.6 million.

Some transplant doctors and bioethicists praised N.K.R. for improving matches and efficiency, but dozens raised concerns about a private company controlling access to a national resource.

Key Topics

Crypto, United States, Health, Organ Donation, Kidney Transplant, Nonprofit, For-profit