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The Dutch national living donor kidney exchange program
Marry de Klerk1, Karin M Keizer, Frans H J Claas
1Department of Internal Medicine - Transplantation, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. marry.deklerk@erasmusmc.nl
Summary
The Dutch living donor kidney exchange program successfully matches incompatible donor-recipient pairs, reducing wait times for kidney transplants. This program benefits both ABO blood type and cross-match incompatible candidates.
Area of Science:
- Nephrology
- Transplantation Immunology
- Public Health
Background:
- The waiting time for deceased-donor kidney transplantation in the Netherlands has reached 4-5 years.
- Expanding the donor pool is crucial to address the growing demand for kidney transplants.
Purpose of the Study:
- To evaluate the effectiveness of a national living donor kidney exchange program in the Netherlands.
- To determine the program's success in facilitating kidney transplantation for ABO-incompatible and positive cross-match pairs.
Main Methods:
- A collaborative protocol was established among all Dutch kidney transplantation centers.
- An independent organization managed anonymous donor-recipient matching and central cross-match testing.
- Simultaneous surgical procedures were scheduled, with donors traveling to recipient centers.
Main Results:
- Sixty donor-recipient pairs participated in the program within the first year.
- Compatible matches were found for 9 out of 29 ABO-incompatible pairs and 17 out of 31 positive cross-match pairs.
- Five cross-match positive pairs were matched with ABO-incompatible recipients, including type O recipients.
Conclusions:
- The living donor kidney exchange program is a successful strategy to increase kidney transplantation rates.
- The program effectively expands the donor pool without negatively impacting the deceased donor waitlist.
- Participation of both ABO-incompatible and positive cross-match pairs is recommended for optimal program outcomes.