title: Kidney paired donation: principles, protocols and programs.
abstract: Due to the ongoing shortage of deceased-donor organs, novel strategies to augment kidney transplantation rates through expanded living donation strategies have become essential. These include desensitization in antibody-incompatible transplants and kidney paired donation (KPD) programs. KPD enables kidney transplant candidates with willing but incompatible living donors to join a registry of other incompatible pairs in order to find potentially compatible transplant solutions. Given the significant immunologic barriers with fewer donor options, single-center or small KPD programs may be less successful in transplanting the more sensitized patients; the optimal solution for the difficult-to-match patient is access to more potential donors and large multicenter or national registries are essential. Multicenter KPD programs have become common in the last decade, and now represent one of the most promising opportunities to improve transplant rates. To maximize donor-recipient matching, and minimize immunologic risk, these multicenter KPD programs use sophisticated algorithms to identify optimal match potential, with simultaneous two-, three- or more complex multiway exchanges. The article focuses on the recent progresses in KPD and it also reviews some of the differences and commonalities across four different national KPD programs.
authors.affiliation: Department of Nephrology, Fremantle Hospital, Fremantle, WA, Australia School of Medicine and Pharmacology, University of Western Australia, Perth, Australia Organ and Tissue Authority, Canberra, ACT, Australia paolo.ferrari@health.wa.gov.au.
authors.forename: Paolo
authors.initials: P
authors.lastname: Ferrari
authors.affiliation: Department of Internal Medicine and Transplantation, Erasmus MC, University Medical Center, Rotterdam, The Netherlands Dutch Transplant Foundation, Leiden, The Netherlands.
authors.forename: Willem
authors.initials: W
authors.lastname: Weimar
authors.affiliation: NHS Blood and Transplant, NHS, Bristol, UK.
authors.forename: Rachel J
authors.initials: RJ
authors.lastname: Johnson
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, Perth, Australia Department of Nephrology, Sir Charles Gairdner Hospital, Perth, Australia.
authors.forename: Wai H
authors.initials: WH
authors.lastname: Lim
authors.affiliation: Division of Nephrology, Department of Medicine and HLA Laboratory, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada Canadian Blood Services, Organ Donation and Transplantation, Toronto, ON, Canada.
authors.forename: Kathryn J
authors.initials: KJ
authors.lastname: Tinckam
mesh_terms: D000465:Algorithms; D003661:Decision Support Techniques; D046148:Donor Selection / Q000458:organization & administration*; D006648:Histocompatibility; D006801:Humans; D016030:Kidney Transplantation; D019520:Living Donors / Q000600:supply & distribution; D009392:Nephrectomy; D016730:Program Development; D012042:Registries; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000458:organization & administration*
keywords: HLA incompatibility; altruistic donation; blood group incompatibility; kidney paired donation