Paired Exchanges Should Be Part of the Solution to Abo Incompatibility in Living Donor Kidney Transplantation

Es, Woodle; Lf, Ross

doi:10.1097/00007890-199808150-00024

Cited by 20 publications

(19 citation statements)

References 4 publications

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“…2 Kidney-paired donation (KPD) is a strategy to help patients with incompatible donors. [3][4][5][6][7] With KPD, 2 or more incompatible pairs are matched with other incompatible pairs such that multiple compatible transplantations can be performed. Kidney-paired donation, also known as closed-loop kidney swaps, can occur with any number of pairs participating with 2-, 3-, or multiway swaps being possible.…”

Section: W I T H M O R E T H a Nmentioning

confidence: 99%

Kidney Transplant Chains Amplify Benefit of Nondirected Donors

Melcher¹,

Veale²,

Javaid³

et al. 2013

JAMA Surg

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Section: W I T H M O R E T H a Nmentioning

confidence: 99%

Kidney Transplant Chains Amplify Benefit of Nondirected Donors

Melcher¹,

Veale²,

Javaid³

et al. 2013

JAMA Surg

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“…The concept was first introduced by Woodle and Ross (1) and first implemented clinically by Montgomery et al (2). Comprehensive inclusion of compatible pairs in clinical KPD programs would nonetheless be a new paradigm, as evidenced by ongoing contention in the transplant community about whether to pursue compatible paired donation.…”

Section: Working Together Toward a National Kidney Paired Donation Prmentioning

confidence: 99%

Working Together Toward a National Kidney Paired Donation Program

Gentry

Segev

Montgomery

2008

American Journal of Transplantation

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Many researchers have addressed compatible pair participation in kidney paired donation (KPD) programs. The concept was first introduced by Woodle and Ross (1) and first implemented clinically by Montgomery et al. (2). Comprehensive inclusion of compatible pairs in clinical KPD programs would nonetheless be a new paradigm, as evidenced by ongoing contention in the transplant community about whether to pursue compatible paired donation.In their 2006 discourses, Veatch (3) and Spital (4) each referred to the unknown probability that a compatible pair could benefit from KPD. The goal of our recent manuscript (5) was to estimate this controversial probability and how it might vary depending on the size and makeup of KPD programs and on the precise definition of benefit. These questions had never been answered. Roth et al. previously suggested that compatible pairs would increase matching opportunities in KPD (6). However, because of methodologic limitations, Roth et al. could not address the critical issue later identified by Veatch and Spital. The maximum cardinality-matching algorithm used by Roth et al. assumes that all matches are equally valuable, and as such cannot capture distinctions such as matching to a beneficial donor versus matching to a medically inferior one. The top-trading-cycles algorithm used by Roth et al. requires logistically impossible 26-way matches.In their letter to which we respond, Roth et al. (7) describe one difference between our analysis and theirs (that their model considers only unrelated donors) but do not mention the more fundamental contrast and its implications. Rather than maximum cardinality matching, which seeks to maximize the number of transplants, we use maximum edgeweight matching that considers the quality of the matches. Although both algorithms were suggested by Edmonds, only maximum edge-weight matching can respect factors such as varying levels of medical benefit to a recipient who enters KPD with his compatible donor. Furthermore, only maximum edge-weight matching can prioritize local and regional matches. Minimizing travel was a central feature of the UNOS proposal for KPD, and the UNOS consensus statement acknowledged that such prioritization would require edge weighting. Moreover, we have recently shown that it is possible to design maximum edge-weight models so that they will also include the maximum number of transplants, if that is desired.The purpose of our study was to demonstrate the high probability that a compatible pair entering a KPD pool would derive a benefit in terms of younger donor age and better matching, because that fact might encourage a widening of compatible pair participation. This is very different from previous simulation work by Roth et al. concerning compatible pairs in KPD pools, but we did not intend to overlook their contributions.We applaud the interest of economists in the field of transplantation. Our interest has been in developing mathematical models that closely reflect actual medical practice. A national KPD program would yield...

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“…PDE transplants involve the exchange of kidneys between two incompatible donor recipient pairs to enable two compatible transplants (1,2). Nonsimultaneous, extended, altruistic-donor (NEAD) transplants are chain transplants that are initiated by an altruistic nondirected donor whose kidney is transplanted into a patient who has an incompatible donor (3).…”

Section: Introductionmentioning

confidence: 99%

Managing Finances of Shipping Living Donor Kidneys for Donor Exchanges

Mast

Vaughan

Busque

et al. 2011

American Journal of Transplantation

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Kidney donor exchanges enable recipients with immunologically incompatible donors to receive compatible living donor grafts; however, the financial management of these exchanges, especially when an organ is shipped, is complex and thus has the potential to impede the broader implementation of donor exchange programs. Representatives from transplant centers that utilize the National Kidney Registry database to facilitate donor exchange transplants developed a financial model applicable to paired donor exchanges and donor chain transplants. The first tenet of the model is to eliminate financial liability to the donor. Thereafter, it accounts for the donor evaluation, donor nephrectomy hospital costs, donor nephrectomy physician fees, organ transport, donor complications and recipient inpatient services. Billing between hospitals is based on Medicare cost report defined costs rather than charges. We believe that this model complies with current federal regulations and effectively captures costs of the donor and recipient services. It could be considered as a financial paradigm for the United Network for Organ Sharing managed donor exchange program.

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Paired Exchanges Should Be Part of the Solution to Abo Incompatibility in Living Donor Kidney Transplantation

Cited by 20 publications

References 4 publications

Kidney Transplant Chains Amplify Benefit of Nondirected Donors

Kidney Transplant Chains Amplify Benefit of Nondirected Donors

Working Together Toward a National Kidney Paired Donation Program

Managing Finances of Shipping Living Donor Kidneys for Donor Exchanges

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