Controversies in kidney paired donation

Area of Science:

• Nephrology
• Transplantation Surgery
• Bioethics

Background:

• Kidney paired donation (KPD) accounted for 10% of US living kidney donations in 2011.
• Global and national registries manage KPD with varying practices.
• Ethical, clinical, and quantitative effectiveness concerns drive these practice variations.

Purpose of the Study:

• To examine the variations in kidney paired donation practices.
• To discuss controversies and challenges in KPD.
• To highlight the need for increased public awareness and participation.

Main Methods:

• Review of existing literature and registry practices in kidney paired donation.
• Analysis of ethical considerations, clinical advisability, and quantitative effectiveness.
• Discussion of controversies including donor travel, chain initiation (domino vs. open), donor operation timing, and compatibility enrollment.

Main Results:

• Donor travel was once standard but is now less common due to evidence on cold ischemia time.
• Debate exists on whether the final donor in a chain should donate immediately (domino/closed chain) or later (open chain).
• Other controversies include simultaneous vs. nonsimultaneous donor operations, enrolling compatible pairs, and desensitization protocols.

Conclusions:

• Significant variations exist in kidney paired donation practices globally and within the US.
• Addressing controversies and challenges is essential for optimizing KPD.
• Expanding public awareness and participation is necessary to increase kidney transplant opportunities.