Kidney Paired Donation

Kidney Paired Donation (KPD) or Paired Exchange, is an approach to living donor kidney transplantation where patients with incompatible donors swap kidneys to receive a compatible kidney. KPD is used in situations where a potential donor is incompatible. Because better donor HLA and age matching are correlated with lower lifetime mortality and longer lasting kidney transplants, many compatible pairs are also participating in swaps to find better matched kidneys. In the United States, the National Kidney Registry organizes the majority of U.S. KPD transplants, including the largest swaps. The first large swap was a 60 participant chain in 2012 that appeared on the front page of the New York Times and the second, even larger swap, included 70 participants and was completed in 2014. Other KPD programs in the U.S. include the UNOS program which was launched in 2010 and completed its 100th KPD transplant in 2014 and the Alliance for Paired Donation.

More than one-third of potential living kidney donors who want to donate their kidney to a friend or family member cannot donate due to blood type or antibody incompatibility. Historically, these donors would be turned away and the patient would lose the opportunity to receive a life-saving transplant. KPD overcomes donor-recipient incompatibility by swapping kidneys between multiple donor-recipient pairs. KPD is also being used to find better donor-recipient matches for compatible pairs who want a lower lifetime mortality and longer lasting transplant.

The first paper outlining the concept of paired exchange was authored by Rappaport and published in 1986. The first recorded paired exchange transplants were organized in South Korea by Dr. Park beginning in 1991. For nearly a decade, only Dr. Park and his team in South Korea utilized this novel approach to facilitate transplants for incompatible donor - recipient pairs. In 1999, the first KPD transplants were performed in Europe followed by the first KPD transplants in the United States in 2000. Over the next ten years the United States would become the most competitive KPD market in the world with more than a dozen KPD programs commencing operations and many KPD programs failing. Outside of the United States, most of the KPD programs have been organized or sponsored by governments which has limited innovation in these programs. Three of the important early KPD programs in the U.S. were the Hopkins program led by Dr. Montgomery and Dr. Segev, the New England Paired Kidney Exchange (NEPKE) led by Dr. Delmonico and Professor Alvin Roth and the Ohio Organ Consortium which later reorganized as two competing programs, the Paired Donation Network (PDN) led by Dr. Woodle and the Alliance for Paired Exchange (APD) led by Dr. Rees.

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