Reciprocity to Increase Participation of Compatible Living Donor and Recipient Pairs in Kidney Paired Donation.
Inclusion of compatible living donor and recipient pairs (CPs) in kidney paired donation (KPD) programs could increase living donor transplantation. We introduce the concept of a reciprocity-based strategy in which the recipient of a CP who participates in KPD receives priority for a repeat deceased donor transplant in the event their primary living donor KPD transplant fails, and then we review the practical and ethical considerations of this strategy. The strategy limits prioritization to CPs already committed to living donation, minimizing the risk of unduly influencing donor behavior. The provision of a tangible benefit independent of the CP's actual KPD match avoids many of the practical and ethical challenges with strategies that rely on finding the CP recipient a better-matched kidney that might provide the CP recipient a future benefit to increase KPD participation. Specifically, the strategy avoids the potential to misrepresent the degree of future benefit of a better-matched kidney to the CP recipient and minimizes delays in transplantation related to finding a better-matched kidney. Preliminary estimates suggest the strategy has significant potential to increase the number of living donor transplants. Further evaluation of the acceptance of this strategy by CPs and by waitlisted patients is warranted.
Division of Nephrology, University of British Columbia, Vancouver, Canada.|Centre for Health Evaluation and Outcomes Sciences, Vancouver, Canada.|Division of Nephrology, Tuft-New England Medical Center, Boston, MA.
J S
JS
Gill
Department of Laboratory Medicine and Pathobiology, University Health Network, University of Toronto, Toronto, Canada.
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http://orcid.org/0000-0002-6638-2887
K
Tinckam
Department of Nephrology and Transplantation, Centre Hospitalier de l'Université de Montréal, Montreal, Canada.|Centre de Recherché du Centre Hospitalier de l'Université de Montréal, Montreal, Canada.
M C
MC
Fortin
Division of Nephrology, University of British Columbia, Vancouver, Canada.|Centre for Health Evaluation and Outcomes Sciences, Vancouver, Canada.
C
C
Rose
Faculty of Nursing, University of Alberta, Alberta, Canada.
K
K
Shick-Makaroff
Canadian Blood Services, Ottawa, Canada.
K
K
Young
Division of Nephrology, University of British Columbia, Vancouver, Canada.
J
J
Lesage
Division of Nephrology, University Health Network, University of Toronto, Toronto, Canada.
E H
EH
Cole
Health Law Institute, Faculty of Law, University of Alberta, Alberta, Canada.
M
M
Toews
Division of Nephrology, University of British Columbia, Vancouver, Canada.
D N
DN
Landsberg
Division of Nephrology, University of British Columbia, Vancouver, Canada.|Centre for Health Evaluation and Outcomes Sciences, Vancouver, Canada.
J
J
Gill
D000368:Aged; D003643:Death; D046148:Donor Selection; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000517:prevention & control*; D006648:Histocompatibility; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D010358:Patient Participation; D009927:Tissue and Organ Procurement / Q000379:methods / Q000592:standards*
clinical research/practice; donors and donation: living; donors and donation: paired exchange; ethics; ethics and public policy; kidney transplantation/nephrology; law/legislation; organ allocation