DOCSLIB.ORG

Transplant Chains – Beyond Paired Kidney Donation Jeffrey Vealea and Garet Hilb Aucla Department of Surgery and Bnational Kidney Registry, Los Angeles, California

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Transplant Chains – Beyond Paired Kidney Donation Jeffrey Vealea and Garet Hilb Aucla Department of Surgery and Bnational Kidney Registry, Los Angeles, California 253 CHAPTER 21 The National Kidney Registry: Transplant Chains – Beyond Paired Kidney Donation Jeffrey Vealea and Garet Hilb aUCLA Department of Surgery and bNational Kidney Registry, Los Angeles, California The advent of chain transplantation is one of the first time. Today, nearly half of living kidney the most exciting advancements to the field over donors are not biologically related to the recipient. CHAI the past 25 years. If transplant programs are able With improved media forms such as the internet, to make a paradigm shift and adopt new attitudes of the relationship between donor and recipient has N DONO cooperation rather than competition, this innovation been stretched to include members of the same has the potential to greatly expand the donor pool faith sanctuary, casual acquaintances or even with high quality living donor organs. unknown individuals. Kidneys from this latter group R Since facilitating its first transplants in 2008, of “altruistic”, “good Samaritan”, or the preferred E the National Kidney Registry (NKR) has become term “nondirected donors” (NDD), those without a X the most productive paired exchange system in the specific patient to whom the kidney is donated, are CHA world, with 62 transplants facilitated in 2009, over increasingly being utilized to trigger multiple chain NG 100 transplants facilitated to date and 200 trans- transplants (Fig. 1). plants forecasted for 2010. By working with leading The emergence of kidney exchanges is some- E - N transplant centers and leveraging cutting edge what vague. The idea that 2 living donor/recipient computer technology, the National Kidney Registry pairs could exchange kidneys to circumvent immu- ATI has broken through many of the barriers that have nologic incompatibility may have been developed ON stalled preceding paired exchange efforts. as early as 1970, however the first publication by A Felix Rapaport appeared in 1986 (2). On October K L EVOLUTION OF CHAIN 3, 2000 the first recorded US paired exchange I TRANSPLANTATION occurred at Rhode Island Hospital. The pairs DN EY Chain Transplantation is a byproduct of The Evolution of Paired Exchange RE “nondirected living donation” and “paired kidney Chains Traditional Paired Exchange G exchanges” which have independently evolved over ISTRY Non Directed time. Although living unrelated and nondirected Two Pair Exchange Altruistic Donor donor transplants had been reported since the R D D Cluster #1 1960’s, it wasn’t until the 1980’s that the opportunity R R D R to expand the living donor pool was appreciated R D (1). Until that point, the perceived low patient Three Pair Exchange D R and graft survival rates were felt to justify living Cluster #2 donation only from genetically related individuals D D D R D with at least one HLA haplotype in common. During R R R D R the 1990’s, kidney transplants between spouses Cluster R D #3 and “emotionally related” individuals markedly D Etc. increased. In 2001, the number of living donors exceeded the number of deceased donors for Figure 1. Variations on paired exchanges. Clinical Transplants 2009, Terasaki Foundation Laboratory, Los Angeles, California 254 VEALE AND HIL consisted of 2 offspring, each of whom wanted to ADVANTAGES OF CHAINS OVER donate to their corresponding mother but had blood TRADITIONAL PAIRED DONATION type incompatibilities (reciprocal A/B and B/A). This historic exchange was performed in sequence by Reciprocity Limits the Options in Dr. Paul Morrissey and Dr. Anthony Monaco with Paired Donation minimal media attention. One of the greatest advantages of chains over The first paired exchange program in the world traditional paired exchange is that chains do not rely was established in Korea in 1999. A year later, the on reciprocal matching. This enables each donor first paired exchange program in the US was started in the chain to be matched with the recipient that by Lloyd Ratner at Johns Hopkins. The Paired yields the longest or highest quality chain. This lack Donation Consortium was established by Steve of reciprocity facilitates more transplants and drives Woodle from the University of Cincinnati in 2002 superior matching performance. For example, the and was the first system to organize exchanges probability of finding a ABO match for a recipient between transplant programs in the United States. using traditional paired exchange (requiring a As other networks and paired exchange programs reciprocal match) is approximately 21% compared were initiated, new and more powerful matching to 46% for a recipient in a chain (Fig. 2). strategies began to emerge. Since there is no reliance on reciprocal match- In 2006, Montgomery, et al, proposed a varia- ing, the software for chains can be programmed to tion on traditional paired donation called “domino find superior age and HLA matches among ABO paired kidney donation” where a nondirected donor compatible patients and donors. In an unpublished was matched to a recipient who had a willing, but simulation study that utilized blood type and HLA incompatible living donor, in turn the incompatible data on 440 unrelated pairs from the UNOS Reg- donor agreed to give their kidney to the first compat- istry, the NKR chain matching program achieved a ible patient on the deceased donor waiting list (3). 50% zero HLA-A,-B,-DR antigen mismatch rate in This set the stage for Michael Rees to expand on the first 50 transplants (e.g. 25 of the 50 matches the “Domino Chain” approach by utilizing the incom- were HLA matched). This improved match quality patible donor as a “bridge donor” who could donate will lead to prolonged graft survival. Figure 3 sug- to another incompatible pair and continue a chain indefinitely, at least in principle. Rees subsequently Why Do Chains Find More Matches? and why are they higher quality matches? started the first “NEAD” (never ending altruistic donor) chain in 2007, facilitating 10 transplants over ABO PRA PROBABILITY a period of about a year (4). In practical applica- 65% x 70% = 46% tion, attempting to extend chains indefinitely was a D R suboptimal strategy as chains could quickly run out Give To of compatible pairs. This lead to broken chains as bridge donors waited long periods of time to donate and continue the chain. In 2009 the National Kidney Registry began facilitating hybrid chains by dynami- ABO PRA PROBABILITY 65% x 70% = 46% cally applying Domino and NEAD approaches to specific segments within a chain thereby balancing chain capacity to pool size in real-time. This mini- R Get Back D mized the chance of broken chains and reduced or eliminated bridge donor wait times, allowing for more GIVE TO GET BACK MATCH PROBABILITY transplants. These additional transplants included 46% x 46% = 21% some recipients on the deceased donor wait list who received living donor kidneys when chains were Figure 2. Probability of compatibility by reciprocal paired donation. systematically terminated. 255 Graft Half Life Donor Withdrawal The point in time when exactly 50% of kidneys are still functioning Deceased Donor Kidneys Donor Recipient 30 Living Donor Kidneys 28.0 NDD Donor Recipient 20 17.8 Years 14.2 D1 R1 D1 R1 10.5 10 D2 R2 R2 0 D2 Standard Standard Living Living Criteria Criteria Donors Donors Donors Donors 0-5 6 0-5 6 Antigen Antigen Antigen Antigen D3 R3 CHAI Match Match Match Match Figure 4. Impact of donor withdrawal on paired Antigen Match Benefit N DONO 5 year graft survival rates donation. 77.2% 74.9% 75.0% simulataneously. The fact that transplantations are 72.2% performed simultaneously during paired exchanges 68.2% Graph 65.6% 66.7% places a tremendous burden on hospitals, operat- R Survival E ing rooms, surgeons, nurses, support staff and Rate X CHA Zero One Two Three Four Five Six the patients. For example, a simultaneous 3-way Donor Recipient Antigen Match paired exchange requires 3 donor surgeons (likely Source: Based on OPTN data as of June 13, 2008 laparoscopically trained), 3 recipient surgeons and NG Figure 3. Benefits of better HLA matching. 6 operating rooms. Very few transplant programs E - N gests that the expected half-life of an HLA-matched in the country can field the surgeons and operating living donor kidney could be as high as 28 years rooms to support this requirement. Conversely, a ATI small center with one donor and recipient surgeon compared to 18 years for one that is completely ON mismatched (5). Better matching will therefore could complete a chain involving the same 6 pa- tients quite easily. The altruistic donor could donate A reduce the competition for organs on the waiting K L list as many recipients currently return to the wait to the first recipient on one day, the recipient’s I list after their first transplant fails. To underscore original incompatible donor could then donate to DN the significance of this, 19% of candidates on the the second recipient the following day (or following EY week, to help their “loved one” who just received deceased donor waiting list have already had one RE transplant (http://www.optn.org). a transplant recover) and so forth. The logistical simplicity of chains levels the playing field and does G ISTRY Chains Improve Transplant Logistics not advantage larger programs when organizing exchanges. Traditional paired exchange transplants are performed simultaneously to eliminate the pos- THE NKR APPROACH sibility of donors withdrawing and creating a situ- ation where a patient’s donor donates a kidney to During 2008, as the NKR was building a core of another pair and the patient does not get a kidney 10 transplant centers and establishing its approach in return. Chain transplantation does not have such to facilitating transplants, 21 transplants were a risky downside. If a donor withdraws in a chain, completed (Fig.
Load more

Recommended publications
  • How Long Will I Have to Wait for a New Kidney?
    Frequently Asked Questions For Waitlisted Patients Questions About My Follow-up On the Waitlist Q: How long will I have to wait for a new kidney? Wait time for a donor organ is dependent upon several factors. These include your blood type, tissue matching, presence of preformed antibodies, and the time from which you began dialysis. o Expected patient waiting times will vary depending upon your geographical location within the United States as well as the local Organ Procurement Organization (OPO). o The following lists of websites can be used a source for information regarding the organ transplant wait list, waiting times, and organ donation. www.unos.org . http://optn.transplant.hrsa.gov . www.transplantliving.org Average wait times in the D.C., Maryland, and Virginia region are as follows: o Blood Group A: 3 years (1095-1190 days) o Blood Group B: 5-6 years (1838-2125 days) o Blood Group O: 5 years (1778-1891 days) o Blood Group AB: 2 years (578-866 days) As of December 4, 2014, your wait time will be calculated from the day you started dialysis (not the date you completed your evaluation) o For patients listed before they started dialysis, your time will still calculate from your date of listing. Q: How often should I expect to be in touch with the transplant center? We typically like to see patients once a year while on the waitlist so that we can keep updated on medical issues that might affect getting a transplant For patients with more significant medical history, we may see you as frequently as every 6 months While we may only be in touch with you every 6-12 months, you should always feel free to contact us at 202-444-3700.
    [Show full text]
  • Editorial the National Kidney Registry
    Editorial The National Kidney Registry Time to Buy In? Bushra Syed and Joshua J. Augustine CJASN 15: 168–170, 2020. doi: https://doi.org/10.2215/CJN.14581119 In this issue of CJASN, Leeser et al. (1) describe patient as measured by panel reactive antibody (PRA). Despite Department of and graft survival in patients who participated in the these risk factors, the National Kidney Registry recip- Nephrology and National Kidney Registry, a nonprofit, 501(c) organi- ients displayed superior death-censored graft survival. Hypertension, Cleveland Clinic, zation founded in 2007 to facilitate living kidney donor It is unclear what may have led to improved outcomes Cleveland, Ohio exchange. Outcomes of recipients of paired kidneys in in the National Kidney Registry recipients. Recipients n5 the National Kidney Registry ( 2363) were compared who participated in the National Kidney Registry may Correspondence: with outcomes in all living donor recipients from have been carefully selected with favorable resources, Dr. Joshua J. registry data (n554,497), control unrelated living do- education, and adherence. National Kidney Registry Augustine, nor recipients (n525,900), and control patients who recipients may also have had lower rates of donor- Department of fi Nephrology and received kidneys through non-National Kidney Regis- speci c antibodies or need for desensitization, although Hypertension, try paired donation (n54535). Because of shipping of such data were not available for the non-National Cleveland Clinic most kidneys, National Kidney Registry transplants had Kidney Registry cohort. Rates of desensitization in the Lerner College of a notably greater cold ischemic time (9 hours versus National Kidney Registry have dropped to ,5% since Medicine, 9500 1 hour for the primary control group).
    [Show full text]
  • The National Kidney Registry: Time to Buy
    CJASN ePress. Published on January 28, 2020 as doi: 10.2215/CJN.14581119 Editorial The National Kidney Registry Time to Buy In? Bushra Syed and Joshua J. Augustine CJASN 15: ccc–ccc, 2020. doi: https://doi.org/10.2215/CJN.14581119 In this issue of CJASN, Leeser et al. (1) describe patient as measured by panel reactive antibody (PRA). Despite Department of and graft survival in patients who participated in the these risk factors, the National Kidney Registry recip- Nephrology and National Kidney Registry, a nonprofit, 501(c) organi- ients displayed superior death-censored graft survival. Hypertension, Cleveland Clinic, zation founded in 2007 to facilitate living kidney donor It is unclear what may have led to improved outcomes Cleveland, Ohio exchange. Outcomes of recipients of paired kidneys in in the National Kidney Registry recipients. Recipients n5 the National Kidney Registry ( 2363) were compared who participated in the National Kidney Registry may Correspondence: with outcomes in all living donor recipients from have been carefully selected with favorable resources, Dr. Joshua J. registry data (n554,497), control unrelated living do- education, and adherence. National Kidney Registry Augustine, nor recipients (n525,900), and control patients who recipients may also have had lower rates of donor- Department of fi Nephrology and received kidneys through non-National Kidney Regis- speci c antibodies or need for desensitization, although Hypertension, try paired donation (n54535). Because of shipping of such data were not available for the non-National Cleveland Clinic most kidneys, National Kidney Registry transplants had Kidney Registry cohort. Rates of desensitization in the Lerner College of a notably greater cold ischemic time (9 hours versus National Kidney Registry have dropped to ,5% since Medicine, 9500 1 hour for the primary control group).
    [Show full text]
  • Transplant Digest Fall 2020
    FALL 2020 TRANSPLANTdigest A BI-ANNUAL PUBLICATION OF MEDSTAR GEORGETOWN TRANSPLANT INSTITUTE Hepatitis C Positive Organs Increase Access to Transplant The wait time for an organ transplant can be significant, ranging from months to years. For patients in need of kidney or liver transplant, one extremely effective approach to shortening wait times is the use of living donor organs. Another newer strategy to further expand organ supply is the use of hepatitis C positive organs from living or deceased donors in patients who do not have the disease. A revolution in the treatment of hepatitis C has allowed physicians to cure the disease with medications Jason Hawksworth, MD, performs surgery using the da Vinci® robot. continued on page 9 Clinical Spotlight: Robotic Liver and Pancreas Surgery MedStar Georgetown Transplant hepatopancreaticobiliary surgeries in Institute is home to one of the only the country.” programs in the country that offers robotic liver and pancreas resection for Prior to the robotic surgical option benign and malignant tumors of the being available, a laparoscopic liver, pancreas, and bile ducts. approach was the only minimally invasive surgical option. While Notes Jason Hawksworth, MD, that approach offered many chief of Robotic Surgery at MedStar patient benefits, there was still a Georgetown Transplant Institute, large volume of cases, about 40 to “Currently, 90 percent of our practice 50 percent, that could not be is focused on robotic surgeries, performed laparoscopically. Robotic and we performed 100 robotic surgery allows us to extend the benefits resections during the last calendar of a minimally invasive approach to a year—the highest volume of robotic broader population of patients.
    [Show full text]
  • Paired Kidney Exchange Transplantation – Pushing the Boundaries
    Transplant International REVIEW Paired kidney exchange transplantation – pushing the boundaries Vijay Kher & Pranaw Kumar Jha Department of Nephrology & SUMMARY Transplant Medicine, Medanta – The The scarcity of living organ donors makes it imperative to develop newer Medicity, Gurgaon, Harayana, India innovations to optimize and maximize the utilization of the available pool. ABO and HLA sensitization are important immunological barriers in renal Correspondence Vijay Kher, Medanta Kidney and transplant and can potentially lead to rejection of almost one-third of the Urology Institute, Division of willing living donors. Paired kidney exchange (PKE) is a rapidly growing Nephrology and Kidney Transplant method used to overcome these barriers and has grown in popularity over Medicine Medanta, The Medicity the last three decades since its introduction in 1986. Evolution of the Gurugram, Haryana, India. matching strategies and use of complex algorithms has led to increase in Tel.: 91-1244141414; the number of possible matches thereby benefiting multiple recipients. The fax: 911-244834111; use of altruistic donors and compatible pairs has also helped in increasing e-mails: [email protected]; the possible exchanges. This review provides an in-depth analysis of the [email protected] evolution, the present global scenario, and the future of PKE. It also dis- cusses the recent trends of advanced donation, trans-organ paired exchange and global kidney exchange and the associated ethical concerns. Transplant International 2020; 33: 975–984 Key words domino kidney paired donation, kidney paired donation, paired kidney exchange, renal transplant Received: 24 June 2019; Revision requested: 2 August 2019; Accepted: 1 July 2020; Published online: 2 August 2020 recipient–donor pair is said to be compatible if their Introduction blood groups match and the crossmatch is negative.
    [Show full text]
  • Kidney and Pancreas Transplant Program Information for Potential Kidney Donors: What You Need to Know About Becoming a Kidney Donor
    Kidney and Pancreas Transplant Program Information for Potential Kidney Donors: What You Need to Know about Becoming a Kidney Donor You have the power to Donate LifeSM INNOVATIVE AND HIGHLY Our Living Donor Program EXPERIENCED LIVING DONOR TEAM This booklet is designed to introduce you to the basic concepts of kidney donation. If you are thinking about being a donor for someone who needs a kidney transplant, we hope that you will find the booklet to be a useful resource. At NewYork-Presbyterian/Weill Cornell Transplant Center, we have the largest Living Donor Kidney Program on the east coast and third largest in the United States, along We have the with one of the top Kidney Paired Donation longest history of Programs (p.4). Although our focus is providing kidney kidney transplants to patients in need, our living transplantation in donor program is designed to first protect you, the New York, potential kidney donor. We have separate medical performing New teams for the donor and the recipient. You will be assigned an independent living donor team to help York’s first Kidney you through the evaluation and donation process, transplant in 1963. and always look out for your best interests. Photo: Parents Brian and Evette each donated a kidney to twin sons Alan and Brian. Who Can Be a Donor? The majority of kidney donors have an established relationship with the person needing a kidney: a relative, spouse, friend, co-worker, or neighbor. However, there are also people who wish to donate a kidney to someone, but do not have a specific recipient in mind.
    [Show full text]
  • Early Graft Losses in Paired Kidney Exchange: Experience from 10 Years of the National Kidney Registry
    Received: 2 October 2019 | Revised: 3 December 2019 | Accepted: 30 December 2019 DOI: 10.1111/ajt.15778 BRIEF COMMUNICATION Early graft losses in paired kidney exchange: Experience from 10 years of the National Kidney Registry Jennifer Verbesey1 | Alvin G. Thomas2,3 | Matt Ronin4 | Jennifer Beaumont5 | Amy Waterman5,6 | Dorry L. Segev3,7,8 | Stuart M. Flechner9 | Matthew Cooper1 1Medstar Georgetown Transplant Institute, Washington, District of Columbia Cooperative kidney paired donation (KPD) networks account for an increasing pro- 2Department of Epidemiology, University of portion of all living donor kidney transplants in the United States. There are sparse North Carolina, Chapel Hill, North Carolina data on the rate of primary nonfunction (PNF) losses and their consequences within 3Department of Surgery, Johns Hopkins KPD networks. We studied National Kidney Registry (NKR) transplants (February 14, University School of Medicine, Baltimore, Maryland 2009 to December 31, 2017) and quantified PNF, graft loss within 30 days of trans- 4 National Kidney Registry, Babylon, New plantation, and graft losses in the first-year posttransplant and assessed potential risk York factors. Of 2364 transplants, there were 38 grafts (1.6%) lost within the first year, 13 5Terasaki Research Institute, Los Angeles, California (0.5%) with PNF. When compared to functioning grafts, there were no clinically sig- 6Department of Nephrology, University of nificant differences in blood type compatibility, degree of HLA mismatch, number of California, Los Angeles, California veins/arteries, cold ischemia, and travel times. Of 13 PNF cases, 2 were due to early 7Department of Epidemiology, Johns Hopkins School of Public Health, venous thrombosis, 2 to arterial thrombosis, and 2 to failure of desensitization and Minneapolis, Minnesota development of antibody-mediated rejection (AMR).
    [Show full text]
  • Inferior Long- Term Allograft and Patient Outcomes Among Recipients of Offspring Living Donor Kidneys
    Received: 11 August 2017 | Revised: 7 December 2017 | Accepted: 12 December 2017 DOI: 10.1111/ajt.14631 ORIGINAL ARTICLE Inferior long-term allograft and patient outcomes among recipients of offspring living donor kidneys J. B. Cohen1,2 | L. Owei2 | D. L. Sawinski1,2 | P. M. Porrett2,3 1Renal-Electrolyte and Hypertension Division, Department of Medicine, University While offspring- to- parent living donor kidney transplantations may represent an ideal of Pennsylvania, Philadelphia, PA, USA donor–recipient combination to optimize long- term transplantation outcomes, the 2 Perelman School of Medicine, University of sex- specific long- term success of these transplantations remains unclear. We hypoth- Pennsylvania, Philadelphia, PA, USA esize that allograft and recipient survivals in offspring- to- parent living donor kidney 3Division of Transplant Surgery, Department of Surgery, Hospital of the University of transplantation differ between men and women due to donor- specific alloimmuniza- Pennsylvania, Philadelphia, PA, USA tion during pregnancy. We retrospectively analyzed long- term allograft and patient Correspondence survival among men and women who received an offspring living donor kidney com- Jordana B. Cohen pared with those who received other haplotype- matched living donor kidneys. Based Email: [email protected] on multivariable Cox proportional hazards modeling of Organ Procurement and Funding information Transplantation Network data from 2001 to 2015, we found that both men and National Heart, Lung, and Blood Institute,
    [Show full text]
  • Asynchronous, Out-Of-Sequence, Transcontinental Chain Kidney Transplantation: a Novel Concept
    American Journal of Transplantation 2009; 9: 2180–2185 C 2009 The Authors Wiley Periodicals Inc. Journal compilation C 2009 The American Society of Transplantation and the American Society of Transplant Surgeons Brief Communication doi: 10.1111/j.1600-6143.2009.02730.x Asynchronous, Out-of-Sequence, Transcontinental Chain Kidney Transplantation: A Novel Concept F. K. Butta,H.A.Gritschb,P.Schulamb, Received 17 January 2009, revised 12 April 2009 and G. M. Danovitchc, A. Wilkinsonc,J.DelPizzod, accepted for publication 29 April 2009 S. Kapure,D.Serurf, S. Katznelsong, S. Busqueh, M. L. Melcherh,S.McGuirei, M. Charltonj,G.Hilk and J. L. Vealeb,* Introduction aDepartment of Surgery, bDepartment of Urology and According to the United Network for Organ Sharing cDepartment of Medicine, UCLA, Los Angeles, CA (UNOS), over 70 000 people are currently listed, awaiting dDepartment of Urology, eDepartment of Surgery and kidney transplantation nationwide, but only 13 148 living fDepartment of Medicine, NYP/Cornell, New York, NY and deceased kidney donors were available in 2008 (1). gDepartment of Medicine, California Pacific Medical One possible solution is to develop a national living donor Center, San Francisco, CA kidney exchange program (2–5). Patients with willing, in- h Department of Surgery, Stanford University Medical compatible living donors would receive a compatible kid- Center, Palo Alto, CA ney through a ’donor exchange‘ with another incompatible iDepartment of Kidney Transplant Services, UCLA, Los Angeles, CA pair. Successful programs utilizing paired exchanges exist jDepartment of Kidney Transplant Services, NYP/Cornell, in the Netherlands (2) and Korea (5,6). An estimated addi- New York, NY tional 2000 kidney transplants could be performed annually kFounder of the National Kidney Registry if a similar program were implemented in the United States *Corresponding author: Jeffrey L.Veale, (7,8).
    [Show full text]
  • Kidney Exchange and the Alliance for Paired Donation: Operations Research Changes the Way Kidneys Are Transplanted
    Kidney Exchange and the Alliance for Paired Donation: Operations Research Changes the Way Kidneys Are Transplanted The MIT Faculty has made this article openly available. Please share how this access benefits you. Your story matters. Citation Anderson, Ross et al. “Kidney Exchange and the Alliance for Paired Donation: Operations Research Changes the Way Kidneys Are Transplanted.” Interfaces 45, 1 (February 2015): 26–42 © 2015 Institute for Operations Research and the Management Sciences (INFORMS) As Published http://dx.doi.org/10.1287/inte.2014.0766 Publisher Institute for Operations Research and the Management Sciences (INFORMS) Version Author's final manuscript Citable link http://hdl.handle.net/1721.1/111107 Terms of Use Creative Commons Attribution-Noncommercial-Share Alike Detailed Terms http://creativecommons.org/licenses/by-nc-sa/4.0/ Kidney Exchange and the Alliance for Paired Donation Ross Anderson, Itai Ashlagi, David Gamarnik, Michael Rees, Alvin E. Roth, Tayfun Sönmez and M. Utku Ünver1 Abstract Many end-stage renal disease sufferers who require a kidney transplant to prolong their lives have relatives or associates who have volunteered to donate a kidney to them, but whose kidney is incompatible with their intended recipient. This incompatibility can be sometimes overcome by exchanging kidneys with another incompatible donor pair. Such kidney exchanges have emerged as a standard mode of kidney transplantation in the United States. The Alliance for Paired Donation (APD) developed and implemented an innovative operations research based methodology of non-simultaneous extended altruistic donor (NEAD) chains, which, by allowing a previously binding constraint (of simultaneity) to be relaxed, allowed better optimized matching of potential donors to patients, which greatly increases the number of possible transplants.
    [Show full text]
  • The Positive Effect of Altruistic Kidney Paired Donor Chains
    SAVING LIVES THROUGH INCREASING AVAILABLE DONOR KIDNEYS: THE POSITIVE EFFECT OF ALTRUISTIC KIDNEY PAIRED DONOR CHAINS A Thesis submitted to the Faculty of The School of Continuing Studies and of The Graduate School of Arts and Sciences in partial fulfillment of the requirements for the degree of Master of Arts in Liberal Studies By Nikita Denise Harmon, B.A. Georgetown University Washington, D.C. April 1, 2013 Copyright 20123 by Nikita Denise Harmon All Rights Reserved ii SAVING LIVES THROUGH INCREASING AVAILABLE DONOR KIDNEYS: THE POSITIVE EFFECT OF ALTRUISTIC KIDNEY PAIRED DONOR CHAINS. Nikita Denise Harmon, B.A. MALS Mentor: Gladys White, Ph.D. ABSTRACT This thesis will propose that altruistic kidney paired donor chains will save more lives of end-stage renal disease (ESRD) patients by increasing the number of available donor kidneys for kidney transplantation in the United States. Altruistic kidney paired donor chains make the most of a living, healthy and willing potential kidney donor who is immunologically incompatible to his or her directed end-stage renal disease patient. These donor chains enable the potential immunologically incompatible living kidney donor to donate to another ESRD patient, who is immunologically compatible, while their directed patient can receive a kidney from another living donor that is immunologically compatible. This thesis will explain in detail the importance of the kidneys via their physical functions in order to sustain life. It will elaborate on the fact that an ESRD patient is limited to two therapeutic choices in order to live. Kidney transplantation is deemed the ideal therapeutic option for providing standard renal functions for ESRD patients.
    [Show full text]
  • Center-Defined Unacceptable HLA Antigens Facilitate Transplants For
    American Journal of Transplantation 2014; XX: 1–7 C Copyright 2014 The American Society of Transplantation Wiley Periodicals Inc. and the American Society of Transplant Surgeons doi: 10.1111/ajt.12734 Center-Defined Unacceptable HLA Antigens Facilitate Transplants for Sensitized Patients in a Multi-Center Kidney Exchange Program L. A. Baxter-Lowe1, M. Cecka2, M. Kamoun3, Abbreviations: CPRA, calculated panel reactive anti- J. Sinacore4 and M. L. Melcher5 body; DSA, donor-specific antibody; KPD, kidney paired donation; MFI, mean fluorescence intensity; 1 NKR, National Kidney Registry; OPTN, Organ Procure- HLA Laboratory, Children’s Hospital Los Angeles, Los ment and Transplantation Network Angeles, CA 2 UCLA Immunogenetics Center, University of California Received 21 October 2013, revised 21 February 2014 Los Angeles, Los Angeles, CA and accepted for publication 26 February 2014 3Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA 4National Kidney Registry, Babylon, NY 5Department of Surgery, Stanford University, Stanford, CA Introduction ÃCorresponding author: Lee Ann Baxter-Lowe, [email protected] Kidney paired donation (KPD) offers new transplant opportunities for patients with a living donor who is willing and medically suitable but HLA or ABO incompatible (1). The usefulness of KPD has been demonstrated by large Multi-center kidney paired donation (KPD) is an single-center KPD programs that have used this approach exciting new transplant option that has not yet for up to 35% of their living donor transplants (2–4). approached its full potential. One barrier to progress Theoretically, multi-center KPD programs with larger pools is accurate virtual crossmatching for KPD waitlists with many highly sensitized patients.
    [Show full text]