Kidney paired donations may expand under pilot program

The Organ Procurement and Transplantation Network in February selected five organizations that work with more than 80 transplant centers to help test a nationwide kidney paired donation system. The pilot project could result in an additional 1,000 live-donor kidney transplants a year.

The United Network for Organ Sharing operates OPTN, which sets the country's organ transplant policy.

"We think [the pilot] is going to be part of the solution to the organ shortage in this country," said John Friedewald, MD, chair of the OPTN/UNOS Kidney Paired Donation Workgroup. "We won't address the entire gap, but it's a good start."

An added 1,000 live-donor kidney transplants a year would represent a 17% increase over the 5,749 such transplants performed in 2009. Another 9,653 transplants were performed last year using kidneys from deceased donors. At this article's deadline, 83,715 U.S. patients were awaiting a kidney transplant.

Often, patients in need of kidneys are able to find willing donors but those donors are not histocompatible. A kidney paired donation matches one incompatible donor-recipient pair to another pair to enable an exchange. Hundreds of such transplants have been performed since 2000. Sometimes transplant centers are able to arrange an extended chain of exchanges, such as a 10-transplant chain spanning four states and performed in July 2007.

That exchange was coordinated by the Alliance for Paired Donation, a Maumee, Ohio, organization selected to take part in the UNOS national pilot project. Other organizations participating in the pilot are Johns Hopkins Hospital in Maryland, the New England Program for Kidney Exchange in Massachusetts, the Ronald Reagan University of California, Los Angeles, Medical Center, and the California Pacific Medical Center.

The organizations would pool the donor-recipient data from more than 80 transplant centers to find matching pairs.

The first phase of the project, which will cost up to $180,000, involves setting up a database to locate compatible donors. That should be "up and running" by this fall, said Dr. Friedewald, a transplant nephrologist at Northwestern Memorial Hospital in Chicago.

Candidates for kidney paired donation will be prioritized based on factors such as how well they match, age, waiting time and geographic proximity, according to UNOS.

If successful, the project could not only widen the pool of donors but also help find kidneys for patients who are the most difficult to match, said Dr. Friedewald, assistant professor of medicine and surgery in the Comprehensive Transplant Center at the Northwestern University Feinberg School of Medicine.

"These are people who otherwise likely won't live to see a transplant," he said. "This isn't just like any other transplant -- these are really challenging transplants."