Broken Chains and Reneging: A Review of 1748 Kidney Paired Donation Transplants

Abstract

Concerns regarding the potential for broken chains and "reneges" within kidney paired donation (KPD) and its effect on chain length have been raised previously. Although these concerns have been tested in simulation studies, real-world data have yet to be evaluated. The purpose of this study was to evaluate the actual rate and causes of broken chains within a large KPD program. All patients undergoing renal transplantation through the National Kidney Registry from 2008 through May 2016 were included for analysis. Broken chains and loops were identified. A total of 344 chains and 78 loops were completed during the study period, yielding a total of 1748 transplants. Twenty broken chains and one broken loop were identified. The mean chain length (number of transplants) within broken chains was 4.8 compared with 4.6 of completed chains (p = 0.78). The most common causes of a broken chain were donor medical issues incurred while acting as a bridge donor (n = 8), donors electing not to proceed (n = 6), and kidneys being declined by the recipient surgeon (n = 4). All recipients involved in a broken chain subsequently received a transplant. Based on the results, broken chains are infrequent, are rarely due to lack of donor motivation, and have no significant impact on chain length.

Inferior long-term allograft and patient outcomes among recipients of offspring living donor kidneys

“…First, paired exchange programs are now extremely well established. [17][18][19][20] These programs provide the option of finding an alternative and potentially more desirable LD for any given LDKT candidate. Second, animal studies of maternal immune responses to the fetus during pregnancy suggest that graft-destructive memory T cells may not necessarily predominate the postpartum repertoire.…”

The first 9 years of kidney paired donation through the National Kidney Registry: Characteristics of donors and recipients compared with National Live Donor Transplant Registries

“…Since inception of the NKR program there have been 8 (0.4%). These real time swap failures were repaired within the network by end of chain paybacks according to established policy [8, 15]. …”

Liver paired exchange: Can the liver emulate the kidney?

“…As transplant centers became more comfortable with KPE, and the complexity of these exchanges increased over distance and over an extended duration through nonsimultaneous chains, the temporal initiation of donor surgery has become less of a concern, although when feasible, attempts are made for the donor to proceed with surgery prior to or simultaneously with the donor of the unmatched pair. Occasionally, donors are unwilling or unable to proceed due to a change in desire to donate or unanticipated health or family circumstances . In such situations, attempts are made to obtain an organ for the nontransplanted recipient by ending a chain with that patient.…”

“…Occasionally, donors are unwilling or unable to proceed due to a change in desire to donate or unanticipated health or family circumstances. (12) In such situations, attempts are made to obtain an organ for the nontransplanted recipient by ending a chain with that patient.…”