Utilizing List Exchange and Nondirected Donation through ‘Chain’ Paired Kidney Donations

Harvard University, Department of Economics, Cambridge, Massachusetts and Harvard Business School, Boston, Massachusetts, USA.
American Journal of Transplantation (Impact Factor: 5.68). 12/2006; 6(11):2694-705. DOI: 10.1111/j.1600-6143.2006.01515.x
Source: PubMed


In a list exchange (LE), the intended recipient in an incompatible pair receives priority on the deceased donor waitlist (DD-waitlist) after the paired incompatible donor donates a kidney to a DD-waitlist candidate. A nondirected donor's (ND-D) kidney is usually transplanted directly to a DD-waitlist candidate. These two established practices would help even more transplant candidates if they were integrated with kidney paired donation (KPD).
We consider a scenario in which the donor of an LE intended recipient (LE-IR) donates to a compatible KPD intended recipient (KPD-IR), and the KPD donor (KPD-D) donates to the waitlist (an LE-chain). We consider a similar scenario in which an ND-D donates to a KPD-IR and the KPD-D donates to the DD-waitlist (an ND-chain).
Using data derived from the New England Program for Kidney Exchange (NEPKE) and from OPTN/SRTR recipient-donor distributions, simulations are presented to evaluate the potential impact of chain exchanges coordinated with KPD. LE donors (LE-D) and ND-D who are ABO-O result in the highest number of additional transplants, while results for ABO-A and B donors are similar to each other. We recommend that both LE and ND donations be utilized through chain exchanges.

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    • "All the surgeries in a cyclic exchange are conducted essentially simultaneously because, in a cycle, every patient-donor pair both gives a kidney and receives one, and so the cost of a broken link would be very high to a pair that first donated a kidney and later failed to receive one. 3 It is this requirement of simultaneity that makes large cycles so demanding logistically. Roth et al. (2006) proposed that the growing number of non-directed donors would allow the simultaneity constraint to be relaxed. When a chain is initiated by a non-directed donor, it can be organized so that the non-directed donor makes the initial donation, and no patientdonor pair has to donate a kidney before they have received one. "
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