Dutch Program Lets Transplant Donor/Recipient Pairs "Swap" with Other Couples according to LWW
A paired kidney exchange program has proven successful in expanding the use of living-donor kidney transplantation in the Netherlands, finding suitable organs for about half of patients with a willing but mismatched donor, reports a study in the December 27 issue of Transplantation.
Dr. Marry de Klerk of Erasmus University Medical Center and colleagues report on the initial experience of the living-donor kidney exchange program, implemented at the seven kidney transplant programs in the Netherlands in 2004. Some patients who need a kidney transplant have a relative or friend who is willing to donate a kidney, but cannot do so because of blood type or immune system incompatibilities. The program matches these donor/recipient pairs to other mismatched couples, in the hope of finding a match for both patients in need. When a match is found, the two donors simultaneously donate kidneys to the other pair's recipient.
One hundred forty-six donor-recipient pairs seven enrolled in the matching program during the first 30 months. A donor was found for 72 recipients who otherwise would not have received a kidney-a success rate of 49 percent.
The exchange program found a match for 64 percent of couples with incompatible blood types ("ABO mismatch"), compared to 35 percent of those with incompatible immune system antibodies ("positive cross-match"). In both groups, the chances of finding a new donor were low after three attempts had been made.
Even in the hardest-to-match group-ABO-mismatched couples in which the recipient had type O blood-the success rate was 17 percent. All of these nine matches were achieved by pairing ABO-mismatched couples to couples with a positive cross-match. "This reflects the efficiency of combining the two categories of donor-recipient combinations into one program,"; the researchers write.
Living kidney donation has become an essential strategy to increase the supply of kidneys for transplantation-in the Netherlands, more than half of kidney transplants now come from living donors. The Dutch program is one of several living-donor kidney exchange programs instituted in recent years. These programs raise some difficult logistical and ethical questions, but the most important is whether they are achieving their primary goal: finding a suitable kidney for patients who would otherwise not receive a transplant.
So far, the Netherlands' living-donor kidney exchange program has found a match for about half of patients with a willing but incompatible donor. The strategy of matching across two categories of incompatibility offers at least a chance of a successful match for even the hardest-to-match cases. "We conclude that paired living donor kidney exchange is an excellent solution, and the first choice for a substantial number of recipients that cannot identify a compatible donor,"; the authors write. They urge further research to find alternative solutions for those "unlucky couples" for whom no suitable match can be found.
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