Kidney-paired donation: benefits and challenges

Living-donor kidney transplantation offers the highest survival benefit for patients with kidney failure, yet access remains limited by immunologic, biologic, geographic and logistical barriers. This review summarized recent developments in kidney-paired donation (KPD), highlights current challenges and outlines future directions to optimize program performance and equity.

KPD has expanded rapidly in the Unites States and globally, with multicenter national and transnational programs demonstrating excellent allograft and patient outcomes. Increasing the use of altruistic donors, advanced donation models and molecular HLA-matching algorithms have improved match rates and compatibility. Despite these advances, significant challenges persist, including overrepresentation of blood group O and highly sensitized candidates, uneven program participation, financial and logistical barriers, and the need for robust ethical frameworks.

Creating a national KPD program that is accessible to all transplant programs and incorporates compatible recipient-donor pairs would significantly improve the opportunities for living-donor kidney transplantation.