Building Kidney Exchange Programmes in Europe—An Overview of Exchange Practice and Activities

Abstract

Background. Considerable differences exist among the living donor Kidney Exchange Programmes (KEPs) that are in use and being built in Europe, contributing to a variation in the number of living donor transplants (Newsletter Transplant; International figures on donation and transplantation 2016). Efforts of European KEPs to exchange (best) practices and share approaches to address challenges have, however, been limited. Methods. Experts from 23 European countries, collaborating on the European Network for Collaboration on Kidney Exchange Programmes Cooperation on Science and Technology Action, developed a questionnaire to collect detailed information on the functioning of all existing KEPs in Europe, as well as their opportunities and challenges. Following a comparative analysis, results were synthesized and interpreted by the same experts. Results. The practices, opportunities and challenges reported by 17 European countries reveal that some of the 10 operating programs are mature, whereas others are in earlier stages of development. Over 1300 transplants were performed through existing KEPs up to the end of 2016, providing approximately 8% of their countries’ living kidney donations in 2015. All countries report challenges to either initiating KEPs or increasing volumes. Some challenges are shared, whereas others differ because of differences in context (eg, country size, effectiveness of deceased donor program) and ethical and legal considerations (eg, regarding living donation as such, nonrelated donors, and altruistic donation). Transnational initiatives have started in Central Europe, Scandinavia, and Southern Europe. Conclusions. Exchange of best practices and shared advancement of national programs to address existing challenges, aided by transnational exchanges, may substantially improve access to the most (cost) effective treatment for the increasing number of patients suffering from kidney disease.

Paired kidney exchange transplantation – pushing the boundaries

“…Further expansion of the PKE has led to international exchanges and evolution of global kidney exchange between low‐ and middle‐income countries (LMIC) and high‐income countries (HIC) [23,24]. Small countries with smaller donor pools have started cross‐border kidney exchanges, and various international cooperation programs have been initiated [15,25]. European Network for Collaboration on Kidney Exchange Programmes (ENCKEP) is a collaboration project of European countries which was started in 2016 with the aim of developing and testing a prototype for transnational PKEs apart from its other functions [15].…”

Global Kidney Exchange: opportunity or exploitation? An ELPAT/ESOT appraisal

“…Most KEP are however not conducted optimally and report a range of problems. Examples include lack of knowledge, small pool sizes, ethical concerns, lack of adequate software, legal barriers, and lack of central coordination [38,79,81]. Some countries such as Romania and Turkey only run single‐center KEP.…”

“…Some countries such as Romania and Turkey only run single‐center KEP. The USA has 3 separate KEP; however, many of its transplant centers are not involved in any of these programs [79]. Rather, numerous regional and single‐center programs exist among approximately 250 living donor transplant centers [79].…”

IP solutions for international kidney exchange programmes

“…The first national kidney exchange programme was established in 2004 in the Netherlands in Europe (De Klerk et al 2005). Currently there are ten countries with operating programmes in Europe (Biró et al 2018), the largest being the UK programme (Manlove and O'Malley 2014).…”

“…The exchange cycles are selected by well-defined optimisation rules, that can vary across countries. The most important constraints are the upper limits on the length of exchange cycles, for examples, two in France, three in the UK and Spain, and four in the Netherlands (Biró et al 2018). The main goal of the optimisation in Europe is to facilitate as many transplants as possible, i.e.…”