title: Current approaches in national kidney paired donation programs.
abstract: Kidney transplantation is the treatment of choice for patients with end-stage renal disease. While living donors provide anywhere from a small to a large fraction of kidneys for transplantation in different countries, at least one-third of these donors are incompatible with their potential recipients. To overcome these challenges, kidney paired donation (KPD) programs have been established that organize donor exchanges to find matches among the pool of incompatible pairs. Each program has developed its own features to accommodate local needs. Reasons for participating in KPD include blood group incompatibility, sensitization of the recipient against the donor, and the potential for improvement in transplant quality (e.g., age difference or graft size), and tissue compatibility. KPD programs use sophisticated algorithms to find matches among the pool of donor-recipient pairs to create simultaneous 2-way, 3-way, or 4-way exchanges or more complex non-simultaneous chains of transplants. These KPD allocation systems should be medically sound and ethically acceptable according to the principles of equity, utility, and justice. The variety of possible exchanges provided by these algorithms allows for maximizing the number of transplants, increasing the quality of transplants, and accommodating patients who are difficult to match. In this review, we describe several examples of successful KPD programs with diverse organizational approaches. By highlighting the strategies used by these programs to meet the needs of their patient populations, we aim to inspire improvements in existing programs and to provide a framework for expanding KPD to better serve international transplant communities.
authors.affiliation: Department of Urology, University of Toledo College of Medicine, Toledo, OH 43614, USA.
authors.forename: Beata
authors.initials: B
authors.lastname: Mierzejewska
authors.forename: Magdalena
authors.initials: M
authors.lastname: Durlik
authors.forename: Wojciech
authors.initials: W
authors.lastname: Lisik
authors.forename: Caitlin
authors.initials: C
authors.lastname: Baum
authors.forename: Paul
authors.initials: P
authors.lastname: Schroder
authors.forename: Jonathan
authors.initials: J
authors.lastname: Kopke
authors.forename: Michael
authors.initials: M
authors.lastname: Rees
authors.forename: Stanislaw
authors.initials: S
authors.lastname: Stepkowski
mesh_terms: D000017:ABO Blood-Group System; D000465:Algorithms; D001315:Australia; D033001:Directed Tissue Donation; D006680:HLA Antigens; D006648:Histocompatibility; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation; D019520:Living Donors; D009426:Netherlands; D056910:Republic of Korea; D009927:Tissue and Organ Procurement / Q000458:organization & administration* / Q000706:statistics & numerical data; D006113:United Kingdom; D014481:United States
chemical_list: D000017:ABO Blood-Group System; D006680:HLA Antigens