title: Historical Matching Strategies in Kidney Paired Donation: The 7-Year Evolution of a Web-Based Virtual Matching System.
abstract: Failure to convert computer-identified possible kidney paired donation (KPD) exchanges into transplants has prohibited KPD from reaching its full potential. This study analyzes the progress of exchanges in moving from "offers" to completed transplants. Offers were divided into individual segments called 1-way transplants in order to calculate success rates. From 2007 to 2014, the Alliance for Paired Donation performed 243 transplants, 31 in collaboration with other KPD registries and 194 independently. Sixty-one of 194 independent transplants (31.4%) occurred via cycles, while the remaining 133 (68.6%) resulted from nonsimultaneous extended altruistic donor (NEAD) chains. Thirteen of 35 (37.1%) NEAD chains with at least three NEAD segments accounted for 68% of chain transplants (8.6 tx/chain). The "offer" and 1-way success rates were 21.9 and 15.5%, respectively. Three reasons for failure were found that could be prospectively prevented by changes in protocol or software: positive laboratory crossmatch (28%), transplant center declined donor (17%) and pair transplanted outside APD (14%). Performing a root cause analysis on failures in moving from offer to transplant has allowed the APD to improve protocols and software. These changes have improved the success rate and the number of transplants performed per year.
authors.affiliation: The Alliance for Paired Donation, Maumee, OH.|Department of Urology, University of Toledo Medical Center, Toledo, OH.
authors.forename: D E
authors.initials: DE
authors.lastname: Fumo
authors.affiliation: Department of Urology, University of Toledo Medical Center, Toledo, OH.
authors.forename: V
authors.initials: V
authors.lastname: Kapoor
authors.affiliation: The Alliance for Paired Donation, Maumee, OH.
authors.forename: L J
authors.initials: LJ
authors.lastname: Reece
authors.affiliation: The Alliance for Paired Donation, Maumee, OH.|Department of Urology, University of Toledo Medical Center, Toledo, OH.
authors.forename: S M
authors.initials: SM
authors.lastname: Stepkowski
authors.affiliation: The Alliance for Paired Donation, Maumee, OH.
authors.forename: J E
authors.initials: JE
authors.lastname: Kopke
authors.affiliation: The Alliance for Paired Donation, Maumee, OH.|Department of Urology, University of Toledo Medical Center, Toledo, OH.
authors.forename: S E
authors.initials: SE
authors.lastname: Rees
authors.affiliation: The Alliance for Paired Donation, Maumee, OH.|Department of Urology, University of Toledo Medical Center, Toledo, OH.
authors.forename: C
authors.initials: C
authors.lastname: Smith
authors.affiliation: Department of Economics, Stanford University, Stanford, CA.
authors.forename: A E
authors.initials: AE
authors.lastname: Roth
authors.affiliation: Department of Medicine, The University of Michigan, Ann Arbor, MI.
authors.forename: A B
authors.initials: AB
authors.lastname: Leichtman
authors.affiliation: The Alliance for Paired Donation, Maumee, OH.|Department of Urology, University of Toledo Medical Center, Toledo, OH.
authors.forename: M A
authors.initials: MA
authors.lastname: Rees
mesh_terms: D000465:Algorithms; D003661:Decision Support Techniques; D046148:Donor Selection / Q000379:methods / Q000458:organization & administration / Q000639:trends; D006801:Humans; D020407:Internet; D016030:Kidney Transplantation; D019520:Living Donors; D015233:Models, Statistical; D009927:Tissue and Organ Procurement / Q000379:methods* / Q000458:organization & administration / Q000639:trends; D014481:United States
keywords: histocompatibility; kidney transplantation/nephrology