Increasing transplantability in Brazil: time to discuss Kidney Paired Donation

Abstract

Introduction: Kidney transplantation (KT) is the best treatment for chronic kidney disease. In Brazil, there are currently more than 26 thousand patients on the waitlist. Kidney Paired Donation (KPD) offers an incompatible donor-recipient pair the possibility to exchange with another pair in the same situation, it is a strategy to raise the number of KT. Discussion: KPD ceased being merely an idea over 20 years ago. It currently accounts for 16.2% of living donors KT (LDKT) in the USA and 8% in Europe. The results are similar to other LDKT. It is a promising alternative especially for highly sensitized recipients, who tend to accumulate on the waitlist. KPD is not limited to developed countries, as excellent results were already published in India in 2014. In Guatemala, the first LDKT through KPD was performed in 2011. However, the practice remains limited to isolated cases in Latin America. Conclusion: KPD programs with different dimensions, acceptance rules and allocation criteria are being developed and expanded worldwide to meet the demands of patients. The rise in transplantability brought about by KPD mostly meets the needs of highly sensitized patients. The Brazilian transplant program is mature enough to accept the challenge of starting its KPD program, intended primarily to benefit patients who have a low probability of receiving a transplant from a deceased donor.

Kidney Paired Exchange: a step too far or a winning hand?

“…In spite of the growing popularity of KPD, this practice has not yet caught on in South America. In this issue of the Brazilian Journal of Nephrology, Medina-Pestana et al 5 and Bastos et al 6 debate the merits and potential pitfalls of KPD. The authors of both articles summarize the literature in the field of KPD, with Bastos et al 6 coming out strongly in favor of KPD, while Medina-Pestana et al 5 express great caution not only with KPD but also with living donation and perhaps transplantation in general.…”

“…Bastos et al 6 cite the positive impact of KPD in facilitating kidney transplantation, especially for patients who are disadvantaged by their blood type or sensitization history. This is supported by published outcomes such as those from the National Kidney Registry (NKR) in the US 4 .…”

“…Furthermore, with regard to living organ donors, they must decide how best to protect their interests and long-term health. By bringing awareness of KPD to the medical community in Brazil, both Medina-Pestana et al 5 and Bastos et al 6 and colleagues are furthering the cause of transplantation in their community. And if one is convinced that kidney transplantation is a life-enhancing and life-extending therapy, then KPD should be considered as an option for all transplant candidates who have a living donor who is medically able but cannot donate a kidney to the intended candidate because of ABO or human leukocyte antigen (HLA) incompatibility.…”