Paired kidney donations to expand the living donor pool: the Western Australian experience

Ferrari, Paolo; Woodroffe, Claudia; Christiansen, Frank

doi:10.5694/j.1326-5377.2009.tb02642.x

Cited by 45 publications

(46 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Paired exchange transplantation is an area where this information may be particularly useful. Paired exchanges and chains are being increasingly used by transplant centers and both have the potential to increase the number of LD transplants (42–44). Ideally, these exchanges should bring equivalent benefit to each recipient.…”

Section: Discussionmentioning

confidence: 99%

“…Ideally, these exchanges should bring equivalent benefit to each recipient. Traditionally, paired exchanges and chains are used in instances of ABO incompatibility or the presence of donor-specific antibody (42–48). Our data suggest two points: first, donor age and degree of HLA mismatch should be considered in the paired exchange process; second, recipients with a compatible donor older than 65 years and an incompatible donor younger than 65 years may prefer the exchange process rather than proceeding with the older compatible donor.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Consideration of Donor Age and Human Leukocyte Antigen Matching in the Setting of Multiple Potential Living Kidney Donors

et al. 2011

View full text Add to dashboard Cite

Background Defining living donor (LD)-related risk factors affecting kidney transplant outcome will allow better donor selection and more educated informed consent when there is more than one potential donor. We studied risk factors in a large cohort at a single institution. Methods We reviewed 1632 recipients who underwent LD kidney transplantation at the University of Minnesota between January 1, 1990, and October 1, 2009. Using Cox regression, we studied the effect of donor and recipient risk factors on patient and graft survival. We specifically examined the effect of donor age and human leukocyte antigen (HLA) matching because these are variables that may help clinical decision making when multiple potential donors exist. Results Mean donor age was 40.6 years for all transplants; 180 (11%) donors were 55 years or older, and 24 (1.5%) donors were older than 65 years. Mean number of HLA mismatches (per transplant) was 2.9 (29.2% of recipients had one to two HLA mismatches, 39.8% had three to four HLA mismatches, and 25% had five to six HLA mismatches). Donor age more than 65 years, five to six HLA mismatches, delayed graft function, and acute rejection were independent predictors of decreased patient and graft survival. When controlling for recipient age, donor age more than 65 years remained a risk factor for worse outcome. Conclusions Our data suggest that advanced donor age (>65 years) and degree of HLA mismatch (≥5) are independent donor-related risk factors associated with worse outcome. When multiple potential LDs exist, it may be ideal to attempt to use a donor younger than 65 years and with less than five HLA mismatches.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Consideration of Donor Age and Human Leukocyte Antigen Matching in the Setting of Multiple Potential Living Kidney Donors

et al. 2011

View full text Add to dashboard Cite

show abstract

“…KPD was initially proposed as an exchange of donors between two pairs (a two‐way exchange), surmounting each other's ABO or HLA incompatibility problem by simply exchanging donors and thus completely avoiding immunologic barriers . Using sophisticated matching algorithms and software, KPD donations can be arranged involving multiple pairs per chain (n‐way exchanges) .…”

Section: Principles Of Kpdmentioning

confidence: 99%

Four years of experience with the Australian kidney paired donation programme

et al. 2015

Self Cite

View full text Add to dashboard Cite

SUMMARY AT A GLANCEThis Australian report reviewed the 4-year experience of kidney paired donation programme which provides an alternative source of live donor kidney transplantation. ABSTRACT:New approaches to increase kidney transplantation rates through expansion of live donor kidney transplantation have become necessary due to ongoing shortage of deceased donor organs. These strategies include desensitization in antibody-incompatible transplants to overcome the barrier of blood group incompatibility or human leucocyte antigen antibodies between recipient and donor and kidney paired donation (KPD) programmes. In KPD, a kidney transplant candidate with an incompatible live donor joins a registry of other incompatible pairs in order to find potentially compatible transplant solutions. To match the largest possible number of donor-recipient pairs while minimizing immunologic risk, KPD programmes use sophisticated algorithms to identify suitable matches with simultaneous two-way or more complex multi-way exchanges as well as including non-directed anonymous donors to start a chain of compatible transplantations. Because of the significant immunologic barriers when fewer donor options are available, the optimal solution for difficult-tomatch, highly sensitized patients is access to more potential donors using large multi-centre or national KPD registries. This review focuses on the first 4 years of experience with the Australian multi-centre KPD programme that was established in October 2010.

show abstract

“…The United Network for Organ Sharing (UNOS) launched a national pilot kidney paired donation (KPD) programme at the end of 2010, and many other countries—including The Netherlands, Romania and the UK—have started exchange programmes in the past decade 8. In 2009, Canadian Blood Services (CBS) launched the Living Donor Paired Exchange (LDPE) registry.…”

Section: Exchange Programmes (Eps)mentioning

confidence: 99%

Is it ethical to invite compatible pairs to participate in exchange programmes?

Fortin

2013

J Med Ethics

View full text Add to dashboard Cite

Living kidney transplantation offers the best results for patients with end-stage renal disease (ESRD). This form of transplantation is no longer restricted to genetically or emotionally related donors, as shown by the acceptance of non-directed living anonymous donors, and the development of exchange programmes (EPs). EPs make it possible to perform living kidney transplantation among incompatible pairs, but while such programmes can help increase living organ donation, they can also create a degree of unfairness. Kidney transplant recipients in the O blood group are at a disadvantage when it comes to EPs because they can only receive organs from O donors, whereas O donors are universal donors. This poses a major challenge in terms of distributive justice and equity. A way to remedy this situation is through altruistic unbalanced paired kidney exchange (AUPKE), in which a compatible pair consisting of an O blood group donor and a non-O recipient is invited to participate in an EP. Although the AUPKE approach appears fairer for O recipients, it still raises ethical questions. How does this type of exchange affect the donor/recipient gift relationship? Should recipients in compatible pairs receive a 'better organ' than the one they would otherwise have received from their intended donor? Finally, what is the role of transplant teams in AUPKE? This article will examine the organisational and ethical challenges associated with EPs and AUPKE, and compare different EP policies in countries where such programmes exist.

show abstract

Paired kidney donations to expand the living donor pool: the Western Australian experience

Cited by 45 publications

References 11 publications

Consideration of Donor Age and Human Leukocyte Antigen Matching in the Setting of Multiple Potential Living Kidney Donors

Consideration of Donor Age and Human Leukocyte Antigen Matching in the Setting of Multiple Potential Living Kidney Donors

Four years of experience with the Australian kidney paired donation programme

Is it ethical to invite compatible pairs to participate in exchange programmes?

Contact Info

Product

Resources

About