Paired Kidney Exchange Programs

Paired kidney exchanges are becoming very common and an exciting option for kidney recipient and donor pairs who are not compatible with each other. Previously, people with kidney failure who had an incompatible donor were not able to benefit from the transplant being offered to them. However, paired kidney exchange programs are having a significant impact on the expanding options of living kidney transplants. Paired exchanges are now allowing transplants to occur between incompatible donor pairs and in a few unique ways.

How Does a Paired Kidney Exchange Work?

A paired exchange consists of two or more donor/recipient pairs who are not compatible with each other.  Paired kidney exchanges are a major breakthrough in living donations and are revolutionizing living donor transplants by eliminating incompatibility as a barrier to donation and providing a way for recipients and their incompatible donor to be paired with another incompatible recipient and donor.

In Pair 1, Donor 1 is not compatible with Recipient 1. In Pair 2, Donor 2 is not compatible with Recipient 2. However, Donor 1 is compatible with Recipient 2 and Donor 2 is compatible with Recipient 1. If you, your donor and the other pair are willing to participate in this “exchange,” a comprehensive evaluation process begins. The medical team will complete final medical tests and schedule the transplant on a date that works with everyone. Both transplants usually occur at the same day. This example used 2 pairs, but in fact any number of pairs is possible.

Domino Paired Kidney Exchange

A domino paired kidney exchange starts with a non-directed or altruistic donor. Instead of just one person benefiting from their donation, this donor can allow many incompatible pairs to be transplanted. The difference in the example shown below from the “Paired Kidney Exchange” is that Donor #2 is not compatible with either recipient #1 or #2. As such, the altruistic donor allows the other pairs to be exchanged, and have the domino effect.

Ongoing Donor Chains (Also called Never Ending Donor Chains)

Most recently, altruistic or non-directed donors have begun initiating donor chains which have the potential to facilitate thousands of additional living donor transplants.

  In the example below, donor, #2 does not donate in this exchange. Donor #2 is referred to as the “bridge donor” for the next “chain”. Donor #2 functions in the same role as the altruistic donor in this example. This chain could continue, over and over again with a new bridge donor.This example uses 2 pairs and the altruistic donor, but any number of pairs could be transplanted.

Kidney Donor Waiting List Exchange

If a paired exchange cannot be found, living donors in certain areas of the country may be eligible for living kidney donor list exchange. In this type of exchange, a kidney donor who is not compatible with their intended recipient offers to donate to a stranger on the waiting list. In return, the intended recipient advances on the waiting list for a deceased donor kidney. This type of living donation is also referred to as list-paired exchange and living donor/deceased exchange. Since the growth of the different paired kidney exchange, waiting list exchanges have become less popular.