By Jack Fassnacht, J.D.
Kidney Transplant Recipient
Past Chair – NKF TransAction Committee
At Large Member – UNOS Kidney Committee
It's not always easy for a kidney patient in need of a transplant to find a willing, compatible living donor, one whose blood and tissue type allow for a successful transplant. It's even more frustrating when a kidney patient finds a willing living donor, but the donor turns out to have an incompatible kidney.
One way around this problem of incompatible recipient-donor pairs is to find another incompatible recipient-donor pair where the donor in each pair is compatible with recipient in the other pair, so each donor can donate a kidney to the recipient in the other pair. This type of cross matching, often called kidney paired donation or KPD, has been occurring for some time, but only within a handful of state and regional transplant programs, and not yet on a national basis where the potential benefits are even greater. You may have read in the news about kidney paired donations involving two, three and sometimes even more recipient/donor pairs. When three or more pairs are involved it's often referred to as a “chain.”
In 2004, the Organ Procurement Transplant Network (OPTN), the administrative body that maintains the national registry of transplant candidates, began looking into the possibility of setting up a national kidney paired donation program, and their efforts may soon come to fruition. A pilot KPD program involving four transplant centers will begin in the fall of 2010 and, if all goes well, a national kidney paired donation program may begin as early as next year involving as many transplant centers as volunteer.
There have been lots of hurdles to jump to get to this point. As an initial matter, it took action on the part of Congress to determine that kidney paired donation did not run afoul of the National Organ Transplant Act (NOTA) which forbids donors from receiving compensation for donating organs. There have been many other questions to address: How should the program handle a recipient who has more than one incompatible donor? What should be done about highly sensitized potential recipients, for whom the potential donor pool is small? Should the living donor travel to the recipient's transplant center or vice versa? Who should be responsible for the medical follow up for the living donor? And how can we involve non-directed (altruistic) living donors (NDDs) not linked to a potential recipient in the program?
The United Network for Organ Sharing (UNOS) and, more particularly, the UNOS Kidney Committee which recommends policy changes with respect to kidney donation and transplantation, proposed a two phase plan in which the first Phase, going on now, involves a small number of volunteer transplant centers. In Phase 2, which may start later this year, any transplant center can participate.
The potential to increase the living kidney donor pool by instituting a national kidney paired donation system is significant. It's not the total solution to the problem of the shortage of donor kidneys, but it can be a significant part of the solution.