Donor Kidney Exchanges

Abstract

Kidney transplantation from live donors achieves an excellent outcome regardless of human leukocyte antigen (HLA) mismatch. This development has expanded the opportunity of kidney transplantation from unrelated live donors. Nevertheless, the hazard of hyperacute rejection has usually precluded the transplantation of a kidney from a live donor to a potential recipient who is incompatible by ABO blood type or HLA antibody crossmatch reactivity. Region 1 of the United Network for Organ Sharing (UNOS) has devised an alternative system of kidney transplantation that would enable either a simultaneous exchange between live donors (a paired exchange), or a live donor/deceased donor exchange to incompatible recipients who are waiting on the list (a live donor/list exchange). This Regional system of exchange has derived the benefit of live donation, avoided the risk of ABO or crossmatch incompatibility, and yielded an additional donor source for patients awaiting a deceased donor kidney. Despite the initial disadvantage to the list of patients awaiting an O blood type kidney, as every paired exchange transplant removes a patient from the waiting list, it also avoids the incompatible recipient from eventually having to go on the list. Thus, this approach also increases access to deceased donor kidneys for the remaining candidates on the list.

Domino paired kidney donation: a strategy to make best use of live non-directed donation

“…A donor and recipient who have incompatible blood groups or HLA sensitivity can be matched with another incompatible pair, to result in two compatible transplants (fi gure). [13][14][15][16][17][18][19] Although there are many ways to match up a pool of incompatible pairs, the mathematical technique of optimisation helps to fi nd out which matches will yield the best results. 13 Nevertheless, even in paired-donation programmes in which mathematical optimisation is applied, more than 50% of the incompatible pairs in the pool remain unmatched.…”

Kidney Vending

“…It did not take into account multiple innovative endeavors to increase other sources of donor organs. These include living donor exchange (18), intended candidate donation (19), desensitization protocols for positive cross-match-and blood group-incompatible pairs (18), increased use of donors after circulatory determination of death (20), and increased use of extended-criteria donor kidneys (21). In the United States, perhaps the most promising endeavor of all is the so-called "Organ Donation Breakthrough Collaborative," whereby the best practices of the most successful organ procurement organizations are disseminated to less effective ones.…”

Age-based preferences in paired kidney exchange

“…For each assignment a, let π a be the finest partition of the set of patients such that for each p ∈ π a and each i ∈ p, there are j, j ∈ p, with a i = ω j and a j = ω i . 9 For each assignment a the partition π a is unique and well-defined. We define cardinality of a as the max p∈πa #p. 10 The cardinality of an assignment refers to the size of the largest cycle formed in the assignment.…”

“…1 of living donor-patient pairs by arranging swaps of donors among several pairs [8,9,30]. PKE programs work as clearing houses that periodically search for mutually compatible exchanges of donors in a pool of donor-patient pairs.…”