Donor exchange raises transplant rates

Organ transplants are some of the most complex medical procedures imaginable, especially those that involve a chain of numerous donors. Kidney paired donation, or KPD, is one form of chain strategy and a recent Hopkins study shows that greater use of this exchange mechanism would help more patients receive transplants.

KPD increases the number of potential donors for patients who have an incompatible living donor so that patients can instead receive well-matched kidneys with a lower likelihood of organ rejection.

Previously, patients who needed kidneys were forced to wait until a compatible donor was deceased, but through KPD, kidneys can essentially be exchanged through multiple pairs so that patients can get a compatible kidney sooner. This often starts with a non-directed, or altruistic, donor who begins the domino effect of the kidney exchange chain.

Hopkins has an extensive history in KPD. The world’s first three, five, and six-way KPD exchanges were performed at the Hopkins School of Medicine, and Dorry Segev, an associate professor of surgery and epidemiology, developed mathematical methods for orchestrating the best matches. Hopkins was also the first to use a non-directed donor and to ship the kidneys for exchange.

“Before, if you matched with a center in California they would make their donor travel to Baltimore,” Segev said.

“We were the first center to take an organ and actually ship it from the center where you were matched instead of making the donor travel, and that helps in the expansion of KPD.”

Segev led the research team that recently published new ideas on KPD. Their research indicates that with a growth in the use of KPD, there could be a huge corresponding increase in the number of patients who receive kidney transplants.

And, in fact, the rate of KPD use has been increasing in the United States.

“KPD has reached the point where there is infrastructure in place for every center to be able to do this,” Segev said.

“There are predictions that say that one to two thousand patients per year could benefit from this. What we wanted to do is look at the growth of KPD and see how close we are to being on target for expected utilization of KPD.”

The research team found that the current rate of transplants done in this country through KPD is encouraging, but that we are still far off from the number of transplants that are possible.

“If centers performed KPD at the rates of the highest KPD performance centers in this country right now, we would triple the number of KPDs that we do,” Segev said.

Centers throughout the country could perform an additional 1,000 live donor transplants annually, which would be a tremendous jump. This could help patients avoid the years of dialysis treatment that come with kidney disease as well as save many lives.

One major barrier to increasing the use of KPD is financial; there is no current mechanism through which KPD can be reimbursed.

“[This is] more of a challenge at some transplant centers than at other transplant centers, which is why there is this very wide variability in some centers with no use of KPD, and some centers... where KPD represents almost 40 percent of the transplant volume,” Segev said. “The next step is to try to address these barriers so we can do more of this procedure.”

With the help of this research, the lack of available compatible donor kidneys can become a thing of the past.