The development of a successful multiregional kidney paired donation program.
BACKGROUND
Kidney paired donation (KPD) is increasing the number of living donor transplants. Two major obstacles prevent moving KPD forward in the United States: (1) achieving a critical mass of pairs to efficiently find matches and (2) efficiently coordinating KPD transplants between multiple transplant centers. Two large regional programs, The New England Program for Kidney Exchange (NEPKE) and the Mid-Atlantic Paired Exchange Program (MAPEP) have developed a system of protocols to effectively increase the number of KPD transplants.


METHODS
Incompatible pairs and nondirected donors (NDD) are referred to the system through transplant centers. Donor and recipient ABO, human leukocyte antigen, and recipient human leukocyte antigen antibody screening are used to determine potential matches. Utilization of a computer optimization algorithm matches pairs in two- and three-way exchanges, NDD chains, and list exchange chains. Team conference calls regarding transfer of information, crossmatches, surgery date, coordination of simultaneous donor nephrectomies, and other issues are coordinated as needed.


RESULTS
Ten matches moved forward to donation and transplantation, and one is pending. Eight of these matches involved NDD chains, two 2-way exchanges, and 1 a list exchange chain. These matches resulted in 27 transplants. Eighteen transplants occurred in NEPKE-only transplant centers, four in MAPEP-only centers, and an additional five were crossregional.


CONCLUSIONS
The collaboration of NEPKE and MAPEP has demonstrated that crossregional coordination is feasible and expands the number of transplants performed beyond the capability of either program alone, especially when combined with computer optimization and multiple-type matches of three-way, NDD chains, and list exchange chains.
Hanto
Ruthanne L
RL
New England Organ Bank, New England Program for Kidney Exchange, One Gateway Center, Newton, MA, USA. RHanto@neob.org
Reitsma
William
W
Delmonico
Francis L
FL
D000017:ABO Blood-Group System / Q000276:immunology; D001787:Blood Group Incompatibility / Q000276:immunology; D006680:HLA Antigens / Q000276:immunology; D006650:Histocompatibility Testing; D006801:Humans; D007668:Kidney; D016030:Kidney Transplantation / Q000276:immunology*; D019520:Living Donors / Q000706:statistics & numerical data*; D009511:New England; D012040:Regional Health Planning / Q000458:organization & administration; D012042:Registries / Q000706:statistics & numerical data; D012984:Software; D009927:Tissue and Organ Procurement / Q000458:organization & administration*; D014850:Waiting Lists
D000017:ABO Blood-Group System; D006680:HLA Antigens