title: Kidney transplant chains amplify benefit of nondirected donors.
abstract: OBJECTIVE
  Despite the potential for altruistic nondirected donors (NDDs) to trigger multiple transplants through nonsimultaneous transplant chains, concerns exist that these chains siphon NDDs from the deceased donor wait list and that donors within chains might not donate after their partner receives a transplant.
  
  
  OBJECTIVE
  To determine the number of transplantations NDDs trigger through chains.
  
  
  METHODS
  Retrospective review of large, multicenter living donor-recipient database.
  
  
  METHODS
  Fifty-seven US transplant centers contributing donor-recipient pairs to the database.
  
  
  METHODS
  The NDDs initiating chain transplantation.
  
  
  METHODS
  Number of transplants per NDD.
  
  
  RESULTS
  Seventy-seven NDDs enabled 373 transplantations during 46 months starting February 2008. Mean chain length initiated by NDDs was 4.8 transplants (median, 3; range, 1-30). The 40 blood type O NDDs triggered a mean chain length of 6.0 (median, 4; range, 2-30). During the interval, 66 of 77 chains were closed to the wait list, 4 of 77 were ongoing, and 7 of 77 were broken because bridge donors became unavailable. No chains were broken in the last 15 months, and every recipient whose incompatible donor donated received a kidney. One hundred thirty-three blood type O recipients were transplanted.
  
  
  CONCLUSIONS
  This large series demonstrates that NDDs trigger almost 5 transplants on average, more if the NDD is blood type O. There were more blood type O recipients than blood type O NDDs participating. The benefits of transplanting 373 patients and enabling others without living donors to advance outweigh the risk of broken chains that is decreasing with experience. Even 66 patients on the wait list without living donors underwent transplantation with living-donor grafts at the end of these chains.
authors: Department of Surgery, Stanford University, 750 Welch Rd, Ste 200, Palo Alto, CA 94025, USA. melcherm@stanford.edu
authors: Marc L
authors: ML
authors: Melcher
authors: Jeffrey L
authors: JL
authors: Veale
authors: Basit
authors: B
authors: Javaid
authors: David B
authors: DB
authors: Leeser
authors: Connie L
authors: CL
authors: Davis
authors: Garet
authors: G
authors: Hil
authors: John E
authors: JE
authors: Milner
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D046148:Donor Selection / Q000379:methods*; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D019520:Living Donors / Q000600:supply & distribution*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014019:Tissue Donors / Q000600:supply & distribution; D009927:Tissue and Organ Procurement / Q000458:organization & administration*; D014481:United States; D014850:Waiting Lists; D055815:Young Adult