title: Identifying Opportunities to Increase the Throughput of Kidney Paired Donation.
abstract: BACKGROUND
  Although kidney paired donation (KPD) has led to thousands of transplants, the 2012 KPD Consensus Conference concluded that more could be done. Perceptions are that a large number of match offers never resulted in transplantations, and unfruitful matches have both financial and emotional costs.
  
  
  METHODS
  To describe, quantify, and analyze the unrealized match offers, we studied the matching process from registration to transplantation in the National Kidney Registry, a large KPD registry, over a 25-month period.
  
  
  RESULTS
  Of the 3,180 match offers, 454 were turned down. The most common reasons were the donor was not acceptable (50%) and their recipient had unacceptably high donor-specific antibodies (28%). Of the 2,228 accepted offers, 1,335 advanced to the cell-based cross-match stage because 893 of these were part of chains that fell through. Fifty-five of 887 recorded cell-based cross-matches were positive, 20 donors were unacceptable, and 22 recipients had unacceptably high donor-specific antibodies. Six hundred ninety transplantations were performed.
  
  
  CONCLUSIONS
  Despite the success of KPD, by analyzing the matching process, we identify several strategies to increase the number of KPD transplantations, including recruiting more participants, processing the match offers more quickly at the transplant center level, enhancing the donor preselection tools, improving communication between centers and the registries, and combining desensitization with KPD.
authors.affiliation: 1 Department of Management Science and Engineering, Stanford University, Stanford CA. 2 Department of Urology, UCLA, Los Angeles, CA. 3 Department of Urology, Northshore University Health System, Highland Park, IL. 4 Department of Surgery, Stanford University, Stanford, CA.
authors.forename: Wenhao
authors.initials: W
authors.lastname: Liu
authors.forename: Eric
authors.initials: E
authors.lastname: Treat
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Veale
authors.forename: John
authors.initials: J
authors.lastname: Milner
authors.forename: Marc L
authors.initials: ML
authors.lastname: Melcher
mesh_terms: D033001:Directed Tissue Donation; D046148:Donor Selection; D006680:HLA Antigens / Q000097:blood; D006648:Histocompatibility; D006650:Histocompatibility Testing; D006801:Humans; D007518:Isoantibodies / Q000097:blood; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors / Q000600:supply & distribution*; D017064:Process Assessment, Health Care; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014481:United States
chemical_list: D006680:HLA Antigens; D007518:Isoantibodies