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Exchange Program Increases Kidney Transplants from Living Donors

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.

About LWW

Lippincott Williams & Wilkins ( LWW.com) is a leading international publisher for physicians, nurses, specialized clinicians, and students. Nearly 275 periodicals and 1,500 books in more than 100 disciplines are published under the LWW brand, as well as content-based sites and online corporate and customer services. LWW is part of Wolters Kluwer Health, a leading provider of information for professionals and students in medicine, nursing, allied health, pharmacy, and the pharmaceutical industry. Wolters Kluwer Health is a division of Wolters Kluwer, a leading multinational publisher and information services company with annual sales of EUR 3.4 billion (2005) and approximately 18,400 employees worldwide.