title: The altruistic unbalanced paired kidney exchange: proof of concept and survey of potential donor and recipient attitudes.
abstract: BACKGROUND
  Altruistic unbalanced paired kidney exchanges (AUPKE) use compatible live donor/recipient pairs to facilitate transplants for individuals with incompatible live donors. We report a three donor/recipient pair complex AUPKE. Little is known of the circumstances under which individuals are likely to trade away a compatible live donor or the overall impact that AUPKE could have on the organ supply.
  
  
  METHODS
  (1) A retrospective analysis of live donor renal transplants was performed using United Network for Organ Sharing data and our own center experience to determine the potential impact of AUPKE. (2) At initial evaluation, potential donors and recipients were administered a survey regarding attitudes toward AUPKE using a 5-point Likert Scale.
  
  
  RESULTS
  (1) One thousand three hundred ninety-six (22.8%) ABO compatible but nonidentical live donor transplants were performed in the United States in 2005. Ninety-one percent of donors were blood group O. (2) Recipient survey respondents were more likely than donors (P=0.002) to favor participation in AUPKE with no advantage to themselves. A number of circumstances increased the propensity to view AUPKE favorably (P<0.05).
  
  
  CONCLUSIONS
  (1) AUPKE can have a profound impact on the kidney supply. (2) By using ABO compatible but nonidentical donors, AUPKE can be performed at individual centers without requiring large sharing networks. (3) O recipients with incompatible donors are likely to be the primary beneficiary of AUPKE. (4) Attitudes are not static and can be influenced in favor of participation if there is a perceived benefit to the recipient. (5) Both donors and recipients are more willing to participate if their intended recipient or donor is enthusiastic about participating. (6) AUPKE reflects a paradigm shift for live donation, converting a private resource (the donor) to a shared one.
authors.affiliation: Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA. lr2182@columbia.edu
authors.forename: Lloyd E
authors.initials: LE
authors.lastname: Ratner
authors.forename: Abbas
authors.initials: A
authors.lastname: Rana
authors.forename: Emily R
authors.initials: ER
authors.lastname: Ratner
authors.forename: Victoria
authors.initials: V
authors.lastname: Ernst
authors.forename: Joan
authors.initials: J
authors.lastname: Kelly
authors.forename: Donald
authors.initials: D
authors.lastname: Kornfeld
authors.forename: David
authors.initials: D
authors.lastname: Cohen
authors.forename: Ilona
authors.initials: I
authors.lastname: Wiener
mesh_terms: D000017:ABO Blood-Group System; D000328:Adult; D000533:Altruism; D001294:Attitude to Health; D001787:Blood Group Incompatibility; D046148:Donor Selection; D005260:Female; D006306:Health Surveys; D006648:Histocompatibility; D006801:Humans; D033181:Information Dissemination; D016030:Kidney Transplantation / Q000276:immunology / Q000523:psychology*; D019520:Living Donors / Q000523:psychology; D018579:Patient Selection; D014019:Tissue Donors / Q000523:psychology*
chemical_list: D000017:ABO Blood-Group System