The impact of organ blood type conversion on kidney paired donation: A simulation and optimization study

Recent advances in immunology demonstrate the potential to convert donor organs to blood type O, offering a solution to ABO (blood group) incompatibility in kidney paired donation (KPD). This study evaluates the impact of such conversion on KPD program performance. We developed a mathematical model to determine optimal kidney allocations in a kidney exchange pool. Using data from the Canadian Transplant Registry, we performed a Monte Carlo simulation to assess how varying levels of blood type conversion impact the number of transplants over a 10-year horizon. We found that converting 15% of non-O donors increased transplant rates by 26% and reduced average waiting time by 2.3 months for recipients transplanted in the KPD program, with most benefits achieved at this conversion level. Improvements are observed across most blood groups, especially for the O blood type, and across all sensitization levels. Direct donations from converted donors to their originally intended recipients in ABO-incompatible-only pairs may slightly reduce the overall benefits of blood type conversion. Organ blood type conversion offers a promising strategy to increase both efficiency and access in the KPD program. However, targeted implementation and careful policy design to support continued participation are essential to maximize its benefits.