A Way to Increase Kidney Transplant Recipients

A new strategy could nearly double the number of recipients who would benefit from living, nondirected (LND) kidney donations and improve transplant outcomes, according to a new study.

Currently, three models exist for choosing recipients of LND donor kidneys in the United States: transplanting into the healthiest patients on the transplant waiting list, administered by the United Network of Organ Sharing (UNOS, Richmond,VA, USA), who are the most likely to have successful outcomes; donation to patients at greatest need, which would be most likely to yield poor transplant outcomes; or giving the organ to the patients at the top of the transplant waiting list regardless of need or expected outcome.

Under the new strategy, called the "domino-paired donation” model, developed by investigators at the Johns Hopkins University School of Medicine (Baltimore, MD, USA), the LND donor's gift is allocated to a combined pool of incompatible donor-patient pairs, initiating a chain of matches. First, the LND donor's kidney is matched to a recipient who has a willing but incompatible donor. The recipient's incompatible donor can, in turn, agree to give a kidney to the next compatible patient on the transplant waiting list, which could lead to a cascade of donor-recipient matches, producing a domino effect.

The investigators developed an optimized algorithm, in which they simulated the number of transplants that could occur in the domino-paired donation model, and compared that with the actual number of transplants that occurred in the United States using LND donor kidneys. Their results show that the domino-paired donation model would result in 583 transplants, instead of the 302 that have actually taken place. The study was reported in the July 29, 2006, issue of The Lancet.

The investigators, led by Dr. Robert A. Montgomery of Johns Hopkins, believe that this model will gain wide acceptance because it would be an ethical way to increase the chances of a good outcome. Furthermore, this tactic would help patients who have the greatest difficulty in being matched due to their blood type or human leukocyte antigen (HLA) sensitization, and thus have to wait longer for a suitable kidney.



Related Links:
Johns Hopkins University School of Medicine
United Network of Organ Sharing