Methods and systems are provided for transplantation of a biological material to a plurality of recipients from a plurality of donors. One or a series of paired donations are made, where one or more donors and/or recipients can be international in origin. Improved care and cost savings are obtained by shifting time-based burdens； i.e., dialysis versus transplantation. Additional transplants, including transplants involving international pariticipants, results in the improvement of local and global healthcare.
