There are over 150,000 people in the United States living full and active lives with transplanted kidneys. Kidney transplants are truly a miracle of modern medicine. If you are facing kidney failure and are medically qualified for a transplant, we want you to have the miracle of a kidney transplant. We have even written a book for you called "Finding a Kidney" that will help you navigate this complex process. You can download the book by clicking HERE or you can buy it on Amazon.com. The National Kidney Registry is committed to helping you get a transplant - If you have an incompatible donor or a poorly matched donor -you have come to the right place. We can help you.
Patient BenefitsDialysis vs. Transplant
People facing kidney failure who are medically qualified for transplant surgery have two basic options: stay on dialysis or get a transplant. Transplantation is far superior to long-term dialysis on all fronts. Transplant patients generally live twice as long as those who stay on dialysis and transplant patients are not restricted by the challenging routine of dialysis therapy. These factors and the quality of life improvements lead many people to seek transplants.
In pursuing a transplant, there are two options: a deceased donor transplant or a living donor transplant. Kidneys transplanted from living donors are superior because they last nearly twice as long as kidneys transplanted from deceased donors.Time Matters
Once a person has made the decision to get a transplant, time matters. Studies indicate that the less time the patient is on dialysis, the better the transplant outcome. Receiving a preemptive transplant and never going on dialysis leads to higher transplant success rates.
Not only does time matter but the donor - recipient match matters too. The most significant matching variable that can be improved via paired exchange is the HLA match. The donor age is less significant but can also be improved via paired exchange. Below are charts that show the impact of the HLA match and donor age on transplant outcomes.
Why the National Kidney Registry
The NKR provides patients the best chance of safely finding a well matched donor which increases graft survival and is correlated with more kidney life years. The NKR works with all the top transplant hospitals in the United States and has facilitated more exchange transplants than any other exchange program in the world. Additionally, the patient outcomes from transplants facilitated by the NKR exceed the average U.S. living donor transplant outcomes. We believe this is driven by the improved donor - recipient matches available through the NKR which is the largest living donor pool in the world.
There are some transplant centers that attempt to provide paired exchange services from a "single center." This approach may make the logistics easier (no need to ship kidneys or coordinate surgery dates with other centers) but this "single center" approach cannot equal the NKR's ability to improve HLA and donor age matching which improves transplant outcomes (i.e. the kidney lasts longer). This is because paired exchange is inherently a numbers game and the NKR is the largest paired exchange program in the world and the NKR has, by far, the biggest pool of donors. The larger the pool of donors, the better the matches. Single center programs have limited ability to "repair" a real-time swap failure (e.g. recipient experiences complications during surgery and cannot receive the kidney). If a single center program cannot "repair" a failed swap, the patient, whose paired donor has already donated, is left without a kidney. Single center programs do not have the volume to repair failed swaps quickly. The NKR has successfully repaired many real-time swap failures. The NKR’s solution for resolving real-time swap failures is outlined in our Medical Board Policies. Additionally, paired exchange presents unique challenges related to protecting donors from the financial exposure related to un-covered donor complications. The NKR has a Donor Protection Program which eliminates this exposure. If you are considering enrolling in a single center paired exchange program, you should request a written copy of the center’s 1) policy for repairing failed swaps and 2) policy for protecting donors against un-covered donor complications. If a written copy of these policies are not immediately available or if they are filled with legal language that protects the hospital, you should consider enrolling in the NKR program where these important risks are clearly addressed.
Patients enrolled with the NKR will:
- Increase the chance of a "clean cross-match" eliminating the need for desensitization.
- Reduce the chance of not getting a match or waiting a long time for a match.
- Increase the chance of finding a great HLA match which is correlated with more kidney life years.
- Increase the chance of finding an age compatible donor match which is correlated with more kidney life years.
- Minimize the risk of a real-time swap failure where the patient could be left without a kidney.
Advanced Donation Program
The Advanced Donation Program (ADP) is a paired exchange separated in time. This program allows medically and psychosocially acceptable Donors to donate their kidney before their Intended Recipient receives a kidney at the end of a chain. Some ADP donors have donated only a few weeks before their Intended Recipient was transplanted, some ADP donors may be donating 10 years before their Intended Recipient needs a transplant and some ADP donors have donated in the hope that their Intended Recipient will never need a transplant (or another transplant).
Below are some of the key requirements and disclosures related to this program:
- There is no guarantee that the patient will be transplanted once the ADP donor has donated.
- The ADP donor and recipient must complete and return the consent forms to apply for ADP participation.
- We encourage you to read the published ADP case reports.
- An ADP donor may have up to five intended recipients.
- An ADP recipient may have up to five ADP donors.
- No additional Intended Recipients can be added after the ADP Donor signs the Informed Consent document.
- When an ADP Donor has multiple Intended Recipients, the first appropriate candidate for transplant will receive the ADP Kidney.
- The ADP donor and Intended Recipient can be at different centers but those centers must both be ADP participating centers.
- Intended Recipients must be a kidney transplant recipient or currently have, or be expected to have, some form of renal function impairment.
Click here for a list of transplant centers participating in the Advanced Donation Program.
Patients without Living Donors
The CHIP program helps patients without donors who are either children or are disadvantaged because they are sensitized. Member centers that evaluate Good Samaritan donors and start have the ability to end chains at their centers and get patients transplanted who do not have a living donor. Below is the CHIP program description.
- NKR member centers that have net chains started > 0 may enroll up to 50 candidates in the CHIP program
- Net chains started is the total number of chains that a center starts less the total number of chains a center ends
- CHIP candidates must be children (18 or younger) or sensitized adults
- The most likely blood types to find a CHIP match are "AB" and "A" blood types
- The CHIP program is used as a last resort. The probability of a match dramatically improves when a paired donor(s) are available
Help for Medicaid/Medi-Cal Patients
Medicaid and Medi-Cal patients are typically disadvantaged in paired exchange because these insurance programs will generally not pay for out of state physician's fees which will block matches with out of state donors. The best opportunity for Medicaid/Medi-Cal patients is to convert their insurance to Medicare. NKR Member Centers should be able to assist patients with the conversion to Medicare.