What is Kidney Paired Donation?
Kidney Paired Donation (KPD) is a means to assist donor/recipient pairs to find another pair(s) with whom they can exchange kidneys for a more favorable compatibility.
Why Are There KPD Programs?
Since the demand for kidney transplantation continues to increase and far exceed the supply of deceased donor kidneys, the transplant community identified a new way to utilize willing live donors to achieve more transplants. In the beginning, only donors who were incompatible with their recipient were pooled together to find pairings. But now, some pairs who are compatible are encouraged to join, as are Non-Directed Donors (sometimes known as Altruistic or Good Samaritan donors). Non-directed donation is when a healthy living person donates a kidney to someone they do not know.
Why Participate in a KPD Program?
If you found out that you are incompatible with your recipient, you still have the potential to help your recipient by entering into a KPD Program. This gives your recipient another option for a possible kidney transplant than only being listed on the deceased donor wait list. In addition, it still gives them the potential to receive a living donor kidney transplant which research shows has a better long-term survival than a deceased donor kidney transplant.
Why Should I Participate in a KPD Program if I am Compatible with my Recipient?
If you are asked to participate in a KPD program, it is to find a “better” donor for your recipient. This could be someone who is a better immunological, age, and/or weight match to your recipient. Some donor/recipient pairs choose to participate altruistically as they realize they will still be receiving and giving a living donor kidney, but in addition are helping someone else stop dialysis or avoid it all together. In most cases if there isn’t a better pairing found after a specific time frame, a transplant would be scheduled between you and your recipient.
How is it Determined if I am Compatible with my Recipient?
Initial testing between a donor and a recipient is to determine blood group compatibility. In the United States, approximately one of every three donors is blood type incompatible with their intended recipient. Next, testing is done to determine immunological compatibility. This testing defines if there are no barriers (negative crossmatch) or if there are barriers and how strong these barriers are (positive crossmatch). Recipients may develop immunological barriers making it more difficult to accept a kidney transplant. Recipients who have these barriers are called “sensitized” patients. Sensitization occurs by having exposure to tissue that is non-self. The dominant causes are a history of a previous transplant, pre-transplant blood transfusions, or a history of pregnancy. Testing is done on a recipient to determine if they are sensitized and if so, the degree of their sensitization. How strongly a recipient is sensitized helps transplant centers determine how difficult it may be to find an immunologically compatible donor.
Are There Treatments Available if a Recipient is Sensitized?
Yes. Desensitization therapies are available to help lower a transplant candidate’s immunological response and increase the chance of getting a kidney transplant sooner. Successful desensitization could potentially allow a recipient three opportunities for kidney transplant: with their original living donor, with a deceased donor, or with a donor from a kidney paired donation program. The transplant team will determine the need for desensitization therapy and if your recipient is a candidate.
How Does a Kidney Transplant Compare to Dialysis?
While dialysis is a lifesaving treatment, it basically just removes waste and excess fluid, while a functioning kidney does this and much more. Dialysis only offers about 10% of what a functioning kidney does. Over time, this can have a significant impact on the body causing other serious health problems and complications including:
• Heart Disease
• Bone Disease
• Nerve Damage
• High Blood Pressure
Patients who receive a kidney transplant typically live longer than those who stay on dialysis. The differences in the projected life expectancy between transplant recipients and dialysis patients are shown in the table below from the Journal of the American Society of Nephrology:
Age Dialysis Transplant
18-34 27.2 yrs 41.5 yrs
35-49 6.71 yrs 18.03 yrs
50-59 5.12 yrs 11.18 yrs
60-64 4.32 yrs 7.84 yrs
65+ 3.69 yrs 7.6 yrs
When is the Best Time to Donate?
Research shows that a transplanted kidney works longer the less time that is spent on dialysis or by avoiding it all together. As wait times for a deceased donor kidney transplant continue to increase, having a living donor is the most common and best way to get transplanted and require little or no dialysis. A transplant from a living donor is preferable to a deceased donor for many reasons including improved kidney function.
How does a KPD Program Work to Find Pairings?
Once a pair, or non-directed donor, is entered into a KPD Program, compatible pairings are identified using computer software. The software maximizes the number of matched pairs while providing additional consideration for specific populations such as children and highly sensitized recipients. Once a match is found, the transplant center(s) involved will review records and crossmatch to assure compatibility. Once approved, scheduling for the exchange can take place. If an exchange is happening between different transplant centers, most times the donor has surgery at the transplant center where they were evaluated, and the kidney is transported to the paired recipient’s transplant center for transplantation to take place.
In most cases, the recipient and donor who entered the KPD Program together will have their surgeries the same day when there is an exchange. An exception to this is when a “chain” is started by a Non-Directed Donor (see figures 1 & 2). In these cases, the surgeries for the donor and recipient that entered the KPD Program together may not occur simultaneously.
What Are the Next Steps to Participate in a KPD Program?
All donors and recipients must undergo a complete standard evaluation and approval by the participating transplant centers before they can be entered into a KPD Program. By taking this step, you have:
Living Donors Truly Are Heroes!