Early Experience of Paired Living Kidney Donation in the United Kingdom

Abstract

Paired donation has been introduced successfully in the United Kingdom, adding to living donor transplant activity. The new national program has yielded fewer transplants than initially anticipated but as the scheme evolves, with the use of altruistic, nondirected donors to start a "chain" of transplants, an increase in the number of successful paired donation transplants is anticipated.

Matching under Preferences

“…These allow for a larger number of kidney transplants (compared to those one could perform based on deceased donors only) and thus more lives saved. Centralised clearinghouses for kidney exchange are in operation on a nationwide scale in a number of countries including the US (Roth et al, 2004(Roth et al, , 2005Ashlagi and Roth, 2012), The Netherlands (Keizer et al, 2005) and the UK (Johnson et al, 2008). The problem of maximising the number of kidney transplants performed through cycles and chains is NP-hard (Abraham et al, 2007a), though algorithms based on Mixed Integer Programming have been developed and are used to solve this problem at scale in the countries mentioned (Abraham et al, 2007a;Dickerson et al, 2013;Manlove and O'Malley, 2012;Glorie et al, 2014).…”

Maximum Weight Cycle Packing in Directed Graphs, With Application to Kidney Exchange Programs

“…This stemmed from the fact that none of the four 3-cycles identified in April 2008 led to transplants, for a range of reasons (e.g., a positive crossmatch being discovered late in the process following more detailed tests, a patient and/or a donor becoming ill, a patient deciding to proceed with an antibody incompatible transplantation, etc. -for further details about this, see [22]). Due to the risk involved with 3-cycles, our exact algorithm was already computing optimal ≤ 3-way exchanges subject to the additional constraint that the exchange could involve at most k 3-cycles, for 0 ≤ k ≤ k ′ , where k ′ was the number of 3-cycles in an optimal ≤ 3-way exchange without this constraint.…”

“…However these incompatible patient-donor pairs may be able to exchange kidneys with other pairs in a similar position. Kidney exchange programs have already been established in several countries, for example the USA [33, 2,35], the Netherlands [24,25], South Korea [38,26,37], Romania [29,28] and the UK [34,22].…”

Equipoise: Ethical, Scientific, and Clinical Trial Design Considerations for Compatible Pair Participation in Kidney Exchange Programs

“…After the initial description of the ethical and scientific principles for kidney exchange (8), the field has progressively expanded, with several nationally based kidney exchange programs established over the past several years, including the Dutch, Australian, Canadian, and British programs (9)(10)(11). A single US kidney exchange program, the National Kidney Registry, facilitated over 300 KE transplants in 2013.…”