title: 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.
authors.affiliation: New England Organ Bank, Newton, MA, USA. francis_delmonico@neob.org
authors.forename: Francis L
authors.initials: FL
authors.lastname: Delmonico
authors.forename: Paul E
authors.initials: PE
authors.lastname: Morrissey
authors.forename: George S
authors.initials: GS
authors.lastname: Lipkowitz
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Stoff
authors.forename: Jonathan
authors.initials: J
authors.lastname: Himmelfarb
authors.forename: William
authors.initials: W
authors.lastname: Harmon
authors.forename: Martha
authors.initials: M
authors.lastname: Pavlakis
authors.forename: Helen
authors.initials: H
authors.lastname: Mah
authors.forename: Jane
authors.initials: J
authors.lastname: Goguen
authors.forename: Richard
authors.initials: R
authors.lastname: Luskin
authors.forename: Edgar
authors.initials: E
authors.lastname: Milford
authors.forename: Giacomo
authors.initials: G
authors.lastname: Basadonna
authors.forename: Michael
authors.initials: M
authors.lastname: Chobanian
authors.forename: Beth
authors.initials: B
authors.lastname: Bouthot
authors.forename: Marc
authors.initials: M
authors.lastname: Lorber
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Rohrer
mesh_terms: D002102:Cadaver; D006801:Humans; D016030:Kidney Transplantation; D019520:Living Donors; D009511:New England; D014019:Tissue Donors; D009927:Tissue and Organ Procurement