title: The Incorporation of an Advanced Donation Program Into Kidney Paired Exchange: Initial Experience of the National Kidney Registry.
abstract: The continued growth of kidney paired donation (KPD) to facilitate transplantation for otherwise incompatible or suboptimal living kidney donors and recipients has depended on a balance between the logistics required for patients and the collaborating transplant centers. The formation of chains for KPD and the shipping of kidneys have permitted networks such as the National Kidney Registry (NKR) to offer KPD to patients over a transcontinental area. However, over the last 3 years, we have encountered patient requests for a more flexible experience in KPD to meet their individual needs often due to rigid time constraints. To accommodate these requests, we have developed an Advanced Donation Program (ADP) in which the donor desires to donate by a specific date, but their paired recipient has not yet been matched to a specific donor or scheduled for surgery. After obtaining careful informed consent from both the donor and paired recipient, 10 KPD chains were constructed using an ADP donor. These 10 ADP donors have facilitated 47 transplants, and thus far eight of their paired recipients have received a kidney within a mean of 178 (range 10-562) days. The ADP is a viable method to support time limited donors in a KPD network.
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: S M
authors.initials: SM
authors.lastname: Flechner
authors.affiliation: Department of Surgery, University of Maryland, Baltimore, MD.
authors.forename: D
authors.initials: D
authors.lastname: Leeser
authors.affiliation: Department of Surgery, The Ohio State University, Columbus, OH.
authors.forename: R
authors.initials: R
authors.lastname: Pelletier
authors.affiliation: Living Donor Institute, St. Barnabas Medical Center, Livingston, NJ.
authors.forename: M
authors.initials: M
authors.lastname: Morgievich
authors.affiliation: Department of Surgery, University of Wisconsin, Madison, WI.
authors.forename: K
authors.initials: K
authors.lastname: Miller
authors.affiliation: Department of Surgery, University of Maryland, Baltimore, MD.
authors.forename: L
authors.initials: L
authors.lastname: Thompson
authors.affiliation: Department of Urology, UCLA, Los Angeles, CA.
authors.forename: S
authors.initials: S
authors.lastname: McGuire
authors.affiliation: Research and Education, National Kidney Registry, Babylon, NY.
authors.forename: J
authors.initials: J
authors.lastname: Sinacore
authors.affiliation: Research and Education, National Kidney Registry, Babylon, NY.
authors.forename: G
authors.initials: G
authors.lastname: Hil
mesh_terms: D000328:Adult; D000368:Aged; D033001:Directed Tissue Donation; D046148:Donor Selection / Q000379:methods / Q000458:organization & administration; D005260:Female; D006801:Humans; D007258:Informed Consent; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012042:Registries; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000379:methods / Q000458:organization & administration*
keywords: donors and donation: living, ethics; donors and donation: paired; exchange; kidney transplantation: living donor