Utilizing List Exchange and Nondirected Donation through ‘Chain’ Paired Kidney Donations
Article first published online: 18 SEP 2006
American Journal of Transplantation
Volume 6, Issue 11, pages 2694–2705, November 2006
How to Cite
Roth, A. E., Sönmez, T., Ünver, M. U., Delmonico, F. L. and Saidman, S. L. (2006), Utilizing List Exchange and Nondirected Donation through ‘Chain’ Paired Kidney Donations. American Journal of Transplantation, 6: 2694–2705. doi: 10.1111/j.1600-6143.2006.01515.x
- Issue published online: 18 SEP 2006
- Article first published online: 18 SEP 2006
- Received 7 April 2006, revised 30 June 2006 and accepted for publication 5 July 2006
- Kidney exchange;
- kidney transplantation;
- list exchange;
- non-directed donor;
- optimal matching;
- paired kidney donation
In a list exchange (LE), the intended recipient in an incompatible pair receives priority on the deceased donor waitlist (DD-waitlist) after the paired incompatible donor donates a kidney to a DD-waitlist candidate. A nondirected donor's (ND-D) kidney is usually transplanted directly to a DD-waitlist candidate. These two established practices would help even more transplant candidates if they were integrated with kidney paired donation (KPD).
We consider a scenario in which the donor of an LE intended recipient (LE-IR) donates to a compatible KPD intended recipient (KPD-IR), and the KPD donor (KPD-D) donates to the waitlist (an LE-chain). We consider a similar scenario in which an ND-D donates to a KPD-IR and the KPD-D donates to the DD-waitlist (an ND-chain).
Using data derived from the New England Program for Kidney Exchange (NEPKE) and from OPTN/SRTR recipient-donor distributions, simulations are presented to evaluate the potential impact of chain exchanges coordinated with KPD. LE donors (LE-D) and ND-D who are ABO-O result in the highest number of additional transplants, while results for ABO-A and B donors are similar to each other. We recommend that both LE and ND donations be utilized through chain exchanges.