Having completed the 100th paired kidney transplant in December, the Penn Transplant Institute leads the nation in paired living donor kidney transplantation in a 12-month period. Paired kidney exchange is an option that expands the pool of individuals interested in donating by allowing unmatched donor-recipient pairs to participate in living donor kidney transplantation.
Why Living Donor Kidney Transplant Matters
Living donor kidney transplantation abbreviates the wait for a donor kidney in patients with end-stage kidney disease and increases the likelihood of successful outcomes including kidney graft survival. On average, transplanted kidneys from living donors last years longer than those from deceased donors.
Although the outcomes of kidney transplantation are optimal when the procedure is performed from living donors with compatible blood and tissue antigens, advances in immune therapy now mean that close genetic links and blood types are no longer a rigid requirement for living donorship.
How Paired Living Donor Kidney Transplantation Works
Kidney paired donation (also described as kidney paired exchange) is a process where kidneys are exchanged between an incompatible living donor and a recipient, thus allowing the recipient to receive a better compatible kidney. Incompatibility is most commonly often considered in reference to blood type, but other incompatibilities, such as HLA type, biological concerns (size, age), or time incompatibility, may also be considered.
In its simplest form, paired kidney exchange involves a two-way exchange (i.e., two transplants from incompatible pairs). Additional opportunities for exchange are available in paired exchange chains wherein a linked series of paired donations occur, resulting in matches for many recipients. Sometimes chains can be started by a non-directed donor—a person who donates a kidney but does not have an intended recipient, thereby initiating a chain which can result in donation to a recipient on a deceased donor wait list.
Kidney Paired Donation at the Penn Center for Living Donation
Addressing the dual challenges of incompatibility and the shortage of deceased donor kidneys requires commitment and innovation with the kidney transplant community. The emphasis on paired kidney exchange plays a critical role in expanding access to kidney transplantation, thereby improving outcomes by increasing the available population of potential living donors for transplant candidates. This, in turn decreases or avoids altogether the need for dialysis.
To this end, at the Penn Transplant Institute, all potential kidney donors and kidney transplant candidates with living donors are educated on the options for kidney paired donation at the Penn Medicine
Center for Living Donation.
About the Penn Transplant Institute Kidney Paired Transplantation Program
The Penn Transplant Institute is among the leading centers for paired living donor kidney transplantation in the United States. These high volumes contribute to safer procedures and outstanding patient outcomes at the PTI, including 100% survival for living donor transplants at one year.
At Penn, all potential living donors are educated on paired kidney donation and undergo a comprehensive medical evaluation in order to determine if living kidney donation is safe and appropriate. If approved, the team of medical providers reviews compatibility pairing with their intended recipient. Only when the team feels it is safe to proceed are the matches made and the donor and recipient surgeries scheduled.
At the Penn Transplant Institute, kidney paired donations are facilitated by the National Kidney Registry, which coordinates matching with a compatible recipient and ensures the intended recipient receives a compatible paired living donation. Most kidney paired exchanges take place within four months. For more information about the Paired Kidney Exchange Program at the Penn Transplant Institute, please see our webpage.