The Dutch national living donor kidney exchange program.
The wait time for deceased-donor kidney transplantation has increased to 4-5 years in the Netherlands. Strategies to expand the donor pool include a living donor kidney exchange program. This makes it possible that patients who cannot directly receive a kidney from their intended living donor, due to ABO blood type incompatibility or a positive cross match, exchange donors in order to receive a compatible kidney. All Dutch kidney transplantation centers agreed on a common protocol. An independent organization is responsible for the allocation, cross matches are centrally performed and exchange takes place on an anonymous basis. Donors travel to the recipient centers. Surgical procedures are scheduled simultaneously. Sixty pairs participated within 1 year. For 9 of 29 ABO blood type incompatible and 17 of 31 cross match positive combinations, a compatible pair was found. Five times a cross match positive couple was matched to a blood type incompatible one, where the recipients were of blood type O. The living donor kidney exchange program is a successful approach that does not harm any of the candidates on the deceased donor kidney waitlist. For optimal results, both ABO blood type incompatible and cross match positive pairs should participate.
de Klerk
Marry
M
Department of Internal Medicine - Transplantation, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. marry.deklerk@erasmusmc.nl
Keizer
Karin M
KM
Claas
Frans H J
FH
Witvliet
Marian
M
Haase-Kromwijk
Bernadette J J M
BJ
Weimar
Willem
W
D000017:ABO Blood-Group System; D000328:Adult; D000368:Aged; D001787:Blood Group Incompatibility; D035082:Federal Government; D005260:Female; D006085:Graft Survival; D015276:Health Care Rationing; D006650:Histocompatibility Testing; D006801:Humans; D007668:Kidney / Q000473:pathology; D016030:Kidney Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D040841:Resource Allocation; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000379:methods*; D014850:Waiting Lists
D000017:ABO Blood-Group System