Paired donations touted for kidney transplants

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Paired donations touted for kidney transplants
By Richard A. Marini - Express-News
Web Posted: 09/09/2010 12:00 CDT

An additional 2,000 live-donor kidney transplants could be performed nationwide if more transplant centers instituted kidney paired donation programs, a Methodist Specialty and Transplant Hospital surgeon says.
In a letter published in this week's New England Journal of Medicine, Dr. Adam Bingaman describes how, since launching in March 2008, the hospital's program has performed 83 kidney paired donations.

This includes 22 two-way exchanges (for a total of 44 transplants) and 13 three-way exchanges (involving 39 transplants).

Since the letter was submitted to the medical journal, the total number of donations done at the hospital has surpassed 100.

In a kidney paired donation, a potential recipient and a willing but incompatible living donor are cross-matched with another recipient/incompatible donor pair. In some cases, more than two recipient/donor pairs can be involved.

“The matching is done by computer because it's such a complex process,” Bingaman explained. “Finding a match is like finding two rare puzzle pieces that fit together.”

The study the letter addressed also found the longer the program is in place, the greater percentage of paired transplants is performed.

For example, during the first year, kidney paired donations accounted for 11 percent of live-donor transplants at the hospital. At 18 months, that had increased to 31 percent. And over the past year, 34 percent of live-donor transplants were KPD procedures.

“The message for kidney patients,” Bingaman said, “is not to take ‘no' for an answer. They need to advocate for their own case and find a program that can help patch them with a potential donor.”

Bingaman arrived at his estimate that a national paired donation program would result in 2,000 more transplants annually by assuming that one-third of the estimated 6,000 waiting-list patients who have willing but incompatible donors would find a match through such a program.

In 2009, 16,829 kidney transplants were performed, according to the United Network for Organ Sharing, the nonprofit organization that manages the nation's transplant system. Living donors accounted for 6,387 of these.

Currently, there are more than 108,500 people on the kidney transplant waiting list.

Because there's such a need, UNOS recently launched a pilot program to test the feasibility of a national kidney paired donor program. The pilot involves 77 transplant centers and four coordinating centers, according to UNOS policy analyst Elizabeth Sleeman.

Methodist Specialty and Transplant Hospital is not a participating center.

“We're currently waiting for the centers to submit their donor and recipient names, and hope to do our first match run in October” she said, referring to the computerized matching of donor and recipient pairs. “We think we can eventually get to the point where we're facilitating 1,000 to 2,000 more kidney transplants annually.”

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