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Programs for Donor/Recipient Pairs with Incompatible Blood Types

Kidney donors must have a compatible blood type with the recipient. In living donation, the following blood types are compatible:

So,

However, there are some programs are available to help donor/recipient pairs with blood types that are otherwise incompatible: paired exchange and plasmapheresis.

Exchange Programs

Paired Exchange

Sometimes a loved one may want to donate a kidney but their blood type is incompatible. Some transplant centers will help incompatible pairs of recipient/donors through a process called paired exchange, which involves two living donors and two recipients.

If the recipient from one pair is compatible with the donor from the other pair, and vice versa— the transplant center may arrange for a “swap”—for two simultaneous transplants to take place. This allows two transplant candidates to receive organs and two donors to give organs though the original recipient/donor pairs were unable to do so with each other.

Figure 1
Figure 1: In paired exchange, an incompatible donor/ recipient pair (such as a mother and son that don’t have compatible blood types) are matched with another incompatible donor/recipient pair for a “swap”. Each donor gives a kidney to the other person’s intended recipient.

Both donors and candidates are carefully evaluated and tested medically and psychologically to assure that the benefits outweigh the risks. It is important for both surgeries to be scheduled for the same time in case either donor changes their mind at the time of surgery. Surgeries can take place at the same or different hospitals. It can be advantageous if the surgeries take place at the same hospital though this may mean extra costs of travel and housing for one couple.

Never Ending Altruistic Donor (NEAD) chain

A NEAD™ chain (Never Ending Altruistic Donor chain) begins with one non-directed (altruistic) potential donor. In this program, the non-directed donor gives to a person waiting for a transplant, and that recipient’s willing—but incompatible—donor gives to another person waiting, and so on.

Each living donor in this system gives to a stranger, and the chain of donors is kept going as long as possible.

Figure 2
Figure 2: In A NEAD™ chain, a non-directed potential donor is matched up with a recipient who has a willing, but incompatible donor. Then that recipient’s incompatible donor then gives to another incompatible pair, and so on.

For More Information

If you are interested in one of these exchange programs:

  1. Talk with your transplant hospital. If you’re already working with a transplant hospital: Talk to them about your options. Ask them if any of these programs are an option for your situation, and if so, does that hospital offer them? 

    • If not: contact transplant hospitals (in the recipient’s area) to ask. For a list of
      U.S. transplant hospitals, visit www.unos.org/members/search.asp and select
      “Transplant Centers”.

  2. Contact a transplant hospital that has an exchange program. You can click here for a list of transplant hospitals with exchange programs.
    (However, please note that this list may not be complete—so it’s always best to check with your transplant hospital, or hospitals nearby, first.)

  3. Contact other organizations which might help. Following are links to other organizations which help to facilitate exchanges.(Note: these organizations and their websites are not under the control of the NKF, and NKF assumes no responsibility for their content or services. These links are provided for information purposes only, and should not be considered an endorsement or recommendation by the National Kidney Foundation.)

    4. Alliance for Paired Donation
    The mission of the Alliance for Paired Donation™ is to save lives by significantly reducing the wait time for a kidney transplant through kidney paired donation. For more information, visit www.paireddonation.org.

    National Kidney Registry
    The mission of the National Kidney Registry is to save and improve the lives of people facing kidney failure by increasing the quality, speed, and number of living donor transplants in the world. For more information, visit www.kidneyregistry.org.

    Paired Donation Network
    The Paired Donation Network is dedicated to making living donor kidney transplantation possible for all patients with kidney failure. It includes over 80 kidney transplant programs in 23 states. For more information, visit www.paireddonationnetwork.org.

News and Stories

The Alliance for Paired Donation Announces: First-ever kidney swap performed simultaneously in three states, three time zones
The Alliance for Paired Donation announced that the first three-state kidney exchange occurred on July 30 with patients in North Carolina, Colorado, and Alabama receiving a living donor kidney transplant simultaneously. more info

Plasmapheresis

New protocols consisting of medications, spleen removal, and a form of blood filtering called plasmapheresis are allowing transplant candidates to receive kidneys from live donors with blood types that have traditionally been deemed incompatible.

Until now, a transplant patient could only receive an organ from someone with a compatible blood type. An organ from an incompatible blood type would be perceived as foreign and vulnerable to attack by the recipient's natural antibodies.

Now, through a process of immune conditioning, a recipient is able to receive a kidney from a donor of a different blood type. This new procedure is currently being provided at a limited number of transplant centers.

The new protocol involves testing the proposed recipient to assess the risk of rejection from harmful antibodies. Next the recipient undergoes plasmapheresis, a process involving the removal of the plasma portion of the blood that contains harmful antibodies and the administration of a medication to prevent their production. The patient is then ready to undergo transplant surgery where, in addition to receiving a donor organ, the patient's spleen is removed using minimally invasive surgical techniques. In some cases, spleen removal can be avoided through the use of a new drug that creates similar effects.

Post transplant, the patient undergoes additional plasmapheresis treatments before being discharged from the hospital. He or she will then take the same immunosuppression medications as patients receiving a compatible kidney.

For more information about plasmapheresis, talk to your transplant hospital and ask if this is an option for you.