title: Exchange living-donor kidney transplantation: diminution of donor organ shortage.
abstract: BACKGROUND
  To alleviate the organ shortage, the use of more living donors is strongly recommended world wide. A living donor exchange (swap) program was launched in Korea. After the success of a direct swap program between two families, we have developed the swap-around program to expand the donor pool by enrolling many kinds of unrelated donors. Herein, we report our results of a living donor exchange program.
  
  
  METHODS
  This retrospectively review of 978 recipients of kidney transplants from living donors, included analysis of donor-recipient relationships, mode of donor recruitment, episodes of acute rejection, and 5-year patient/graft survivals.
  
  
  RESULTS
  Transplantation was performed in 101 patients (10.3%) by way of the swap program. The proportion of swap patients among the number of unrelated donor renal transplants has been increasing from 4.2% to 46.6%. The incidence of acute rejection and 5-year patient/graft survival rates were comparable between the groups.
  
  
  CONCLUSIONS
  We have achieved some success in reducing the organ shortage with a swap program in addition to our current unrelated living donor programs without jeopardizing graft survival. Potentially exchangeable donors should undergo strict medical evaluation by physicians and social evaluation by social workers and coordinators as a pre-requisite for kidney transplantation. Expanding the swap around program to a regional or national pool could be an option to reduce the organ donor shortage in the future.
authors.affiliation: Transplantation Center, Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea. kpark@kwandong.ac.kr
authors.forename: K
authors.initials: K
authors.lastname: Park
authors.forename: J H
authors.initials: JH
authors.lastname: Lee
authors.forename: K H
authors.initials: KH
authors.lastname: Huh
authors.forename: S I
authors.initials: SI
authors.lastname: Kim
authors.forename: Y S
authors.initials: YS
authors.lastname: Kim
mesh_terms: D001787:Blood Group Incompatibility; D005190:Family; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality / Q000502:physiology / Q000706:statistics & numerical data*; D007723:Korea; D019520:Living Donors / Q000600:supply & distribution*; D012189:Retrospective Studies; D016019:Survival Analysis