A flexible national living donor kidney exchange program taking advantage of a central histocompatibility laboratory: the Dutch model.
The shortage of deceased donor kidneys for transplantation has resulted in the expansion of living donation programs. A number of possibilities have been explored, since it became clear that donors do not need to be genetically related to their recipients. Apart from classical direct donation, other options such as paired exchange, list exchange, altruistic donation and domino paired exchange programs have been implemented. In the Netherlands, patients who cannot be transplanted with their potential living donor because of ABO blood group incompatibility or a positive crossmatch, have the option to participate in a national paired kidney exchange program. The practical issues related to this program are described. The 5-years experience with the Dutch kidney exchange program is very positive as, so far, 42% of the recipients included have been transplanted. Recommendations are given for a successful implementation of a common kidney exchange program of different transplantation centers focusing on the advantage of a central histocompatibility laboratory.
de Klerk
Marry
M
Dept of Internal Medicine--Transplantation, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Witvliet
Marian D
MD
Haase-Kromwijk
Bernadette J J M
BJ
Weimar
Willem
W
Claas
Frans H J
FH
D033161:Government Regulation; D006287:Health Planning Guidelines; D006291:Health Policy; D006650:Histocompatibility Testing; D006801:Humans; D016030:Kidney Transplantation / Q000331:legislation & jurisprudence; D007753:Laboratories / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D019520:Living Donors / Q000331:legislation & jurisprudence / Q000600:supply & distribution*; D009313:National Health Programs / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D009426:Netherlands; D009937:Organizational Objectives; D016730:Program Development; D015397:Program Evaluation; D009927:Tissue and Organ Procurement / Q000331:legislation & jurisprudence / Q000458:organization & administration*