Altruistic donation through the Alliance for Paired Donation

Kidney paired donation is an evolving strategy for overcoming the incompatibility barrier inherent in living donor kidney transplantation. As evidence of the growing interest in this new approach, more than 800 paired donation transplants have been performed in the United States as of February 2010, greater than half of which were performed in 2008 and 2009. Recent advances in this field have incorporated non-directed or altruistic donors to initiate chains of transplants that are either performed simultaneously, or by utilizing "bridge donors" who continue a nonsimultaneous chain at a later date. In this report from the Alliance for Paired Donation, we summarize our experience with altruistic and bridge donors. The program has utilized 6 altruistic-donor initiated chains that have resulted in 22 transplants and have generated 16 bridge donors. In addition, we report our experience with website registrations and national media exposure that has resulted in over 3500 registrations on the APD website, with 37% expressing interest in altruistic donation. We discuss the financial barriers to paired donation in America, and suggest a solution similar to the CMS-approved organ procurement organization standard acquisition charges for deceased donors. Finally, we propose a new approach to integrate paired donation and deceased donors that would allow altruistic living donors to benefit patients on the waiting list without willing, but incompatible donors and simultaneously eliminate the risk of reneging in nonsimultaneous extended altruistic donor chains. We call this new approach a "reverse list exchange".