Kidney Paired Donation Chains Initiated by Deceased Donors

Area of Science:

• Nephrology
• Transplantation
• Organ Donation

Background:

• Deceased donors (DDs) typically provide one kidney transplant.
• Kidney paired donation (KPD) involves chains of incompatible donor-recipient pairs.
• DDs initiating KPD chains offers a novel strategy for increasing transplants.

Purpose of the Study:

• To model outcomes of various strategies for DDs initiating KPD chains.
• To assess the impact on transplant numbers and waitlist candidates.
• To address concerns regarding blood type O candidates.

Main Methods:

• Simulations based on US deceased donor and waitlist data (2016-2017).
• Modeling of DD-initiated KPD chains using simulated KPD pools.
• Analysis of strategies to mitigate potential disadvantages for blood type O candidates.

Main Results:

• Longer DD-initiated KPD chains increase transplants by up to 5% and reduce DD allocation to the pool by 25%.
• These strategies increase blood type O transplants and free up living donors (LDs) for the waitlist.
• Restricting blood type O DD allocation to end KPD chains with type O LD donations reduces overall KPD transplants.

Conclusions:

• Allocating <3% of DDs to initiate KPD chains could yield up to 290 additional kidney transplants annually.
• This approach facilitates transplantation for highly sensitized and blood type O KPD candidates.
• Proposed strategies benefit patients of all blood types, including type O.