Expanding Kidney Paired Donation Through Participation by Compatible Pairs

TLDR

Kidney paired donation exchanges incompatible donor–recipient pairs, but its use is limited by the difficulty of finding matches; adding compatible pairs could improve match quality and address legal and logistical barriers that have stalled national expansion. The study investigates the impact of allowing compatible donor/recipient pairs to participate in kidney paired donation. The authors used simulated donors and recipients to model KPD outcomes. Including compatible pairs nearly doubles match rates for incompatible pairs—raising single‑center rates from 28.2 % to 64.5 % and national rates from 37.4 % to 75.4 %—and can be implemented immediately at the center level while offering the greatest gains when expanded nationally.

Abstract

In kidney paired donation (KPD), incompatible pairs exchange kidneys so that each recipient receives a compatible organ. This modality is underutilized partly because of the difficulty of finding a suitable match among incompatible pairs. Alternatively, recipients with compatible donors might enter KPD arrangements in order to be matched with a donor predicted to give greater allograft durability or for other altruistic reasons. Using simulated donors and recipients, we investigated the impact of allowing recipients and their compatible donors to participate in KPD. For KPD programs of any size, the participation of compatible donor/recipient pairs nearly doubled the match rate for incompatible pairs (28.2% to 64.5% for single-center program, 37.4% to 75.4% for national program). Legal, logistical, and governmental controversies have hampered the expansion of KPD in the United States by delaying the creation of a national program. The inclusion of compatible pairs into small single-center pools could achieve match rates that would surpass that which could be realized by a national list made up of only incompatible pairs. This new paradigm of KPD can immediately be instituted at the single-center level, while the greatest gains will be achieved by incorporating compatible pairs into a national program.