Past, present and future of kidney paired donation transplantation in India

Abstract

One third of healthy willing living kidney donors are rejected due to ABO blood group incompatibility and donor specific antibody. This increases pre-transplant dialysis duration leading to increased morbidity and mortality on the kidney transplantation waiting list. Over the last decade kidney paired donation is most rapidly increased source of living kidney donors. In a kidney transplantation program dominated by living donor kidney transplantation, kidney paired donation is a legal and valid alternative strategy to increase living donor kidney transplantation. This is more useful in countries with limited resources where ABO incompatible kidney transplantation or desensitization protocol is not feasible because of costs/infectious complications and deceased donor kidney transplantation is in initial stages. The matching allocation, ABO blood type imbalance, reciprocity, simultaneity, geography were the limitation for the expansion of kidney paired donation. Here we describe different successful ways to increase living donor kidney transplantation through kidney paired donation. Compatible pairs, domino chain, combination of kidney paired donation with desensitization or ABO incompatible transplantation, international kidney paired donation, non-simultaneous, extended, altruistic donor chain and list exchange are different ways to expand the donor pool. In absence of national kidney paired donation program, a dedicated kidney paired donation team will increase access to living donor kidney transplantation in individual centres with team work. Use of social networking sites to expand donor pool, HLA based national kidney paired donation program will increase quality and quantity of kidney paired donation transplantation. Transplant centres should remove the barriers to a broader implementation of multicentre, national kidney paired donation program to further optimize potential of kidney paired donation to increase transplantation of O group and sensitized patients. This review assists in the development of similar programs in other developing countries.

Kidney-paired donation to increase living donor kidney transplantation in India: Guidelines of Indian Society of Organ Transplantation – 2017

“…In India, in the absence of national KPD program, only single-center KPD is practiced. [ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 ] Table 2 shows the key elements of success of single-center KPD program at the Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences, Ahmedabad, India, a center which has performed 300 KPD transplants in India. [ 2 3 4 5 6 7 8 9 10 ]…”

“…Transplant rate for difficult-to-match pairs such as O blood group and sensitized patients can be increased by compatible pairs, longer chain, KPD with desensitization, KPD with ABOiKT, use of A2 donor to O patient, expanding the number of acceptable mismatches, national program, and living–deceased donor list exchange. [ 11 39 40 ] Waiting time in KPD is mostly less compared to DDKT. [ 4 44 ] ABOiKT is expensive compared to ABO compatible KPD transplant.…”

“…Single-center KPD program has advantages that donor transport or transport of kidney is not required, surgical care is uniform, cold ischemia time is less, administrative cost is less, and follow-up of DRP is in familiar hospital. [ 11 ] However, multicenter KPD program has advantages of better quality matching and number of KPD due to large donor pool and computer allocation, less stress on the surgical team to carry simultaneous surgery in long chain, and better transplant rate for difficult-to-match DRP. [ 11 ]…”

“…[ 11 ] However, multicenter KPD program has advantages of better quality matching and number of KPD due to large donor pool and computer allocation, less stress on the surgical team to carry simultaneous surgery in long chain, and better transplant rate for difficult-to-match DRP. [ 11 ]…”

Opposition to irresponsible global kidney exchange

“…Better HLA matched kidney transplantation for the compatible pairs will result in better long term outcome and need of re-transplantation which is common cause of sensitization." 10 To link kidney exchange in descriptive sequenced sentences to a reduction in infection-as a validation of such an exchange program-should elicit a responsible concern of implementing "global kidney exchange" in an underdeveloped country, especially in India, where organ trafficking is reported regularly in the media. [11][12][13] Finally, the "global kidney exchange" program has suggested there will be oversight by organizations such as the World Health Organization (WHO) and The Transplantation Society (TTS).…”