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Kidney Recipients - National Kidney Registry - Facilitating Living Donor Transplants
 
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Kidney Recipients

Overview

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.

The first thing that you need to know is that living donor transplants have vastly superior outcomes. The chart below shows that living donor transplants last nearly twice as long as deceased donor transplants.

Living Donor Kidneys Last Longer

The second thing you need to know is that time matters. The faster you can get a transplant, the better the transplant outcome (see chart below). The best case scenario is to get a transplant before you ever go on dialysis. This is called a pre-emptive transplant and is correlated with significantly higher graft survival rates). If you are not able to get a pre-emptive transplant, time still matters so move fast to get the transplant done as soon as possible.

Ten year overall adjusted graft survival - Pre-emptive Living Donor Transplant vs. Dialysis

 

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Why the National Kidney Registry

If you have an incompatible or poorly matched living donor, the National Kidney Registry will give you the best chance of finding a well matched donor. The National Kidney Registry works with most of 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 National Kidney Registry are superior to the average U.S. living donor transplant outcome (see below). We believe this is driven by the improved donor - recipient matches available through the National Kidney Registry.

Graft Survival - NKR Transplants vs. U.S. Living Donor Transplants as of 3/19/2014

Patients with paired donors that are enrolled in the NKR should ask their center for a copy of their personalized Swap Expert printout. The swap expert is an artificial intelligence application developed by NKR to assist patients in speeding up the chance of a match or improve the compatibility of a match. Below are a few examples of swap expert printouts for different types of pairs:

In addition to reducing the time to get a transplant, the quality of the match will impact your transplant outcome. This is especially important for:

  • unsensitized "A" blood type recipients that have "B" donors
  • unsensitized "B" blood type recipients that have "A" donors
  • any recipient that has a PRA score < 50% and has an "O" donor

Why is it relevant? Because these types of incompatible pairs can generally be matched quickly with donors that are highly compatible on dimensions such as age, HLA and size. The Registry allows patients to set preferences that will guide the matching process so that you get the best match possible. Member centers can utilize powerful software such as the "toolbox" and "donor pre-select" to help patients get the best match.

Single center exchange programs

There are some transplant centers in the United States that attempt to provide paired exchange services from a "single center". Although this approach will make the logistics easier (no need to ship kidneys or coordinate surgery dates with other centers) this "single center" approach is likely to delay or even prevent a successful paired exchange transplant. Paired Exchange is inherently a numbers game and the larger the exchange program the higher the probability that the patient will quickly get a great match. A great match will increase graft survival and provide a kidney that lasts longer. The NKR is the largest paired exchange program in the world and provides the best chance for patients to rapidly find a great match. The top NKR Member Centers have a 90%+ match / transplant success rate and have an average wait time of less than 6 months for the completion of NKR paired exchange transplants. For more information on NKR Member Center performance CLICK HERE.

Working with a transplant center that participated 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 (5 NKR patients have received 6 antigen matched kidneys)
  • Increase the chance of finding an age compatible donor match

 

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Why the Match Matters

Registry Member Centers can help you get the best match possible through an Exchange by utilizing the Toolbox and Swap Expert software hosted by the Registry. Below are charts that show the impact of donor age and antigen matching on transplant outcomes.

Donor Age Matters Antigen Match Between Donor and Recipient Matters

 

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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

 

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Next Steps

Click here to review a list of Kidney Transplant Centers.

 

 

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Help for Medicaid/MediCal Patients 

Medicaid and MediCal 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/MediCal patients is to convert their insurance to Medicare. NKR Member Center should be able to assist patients with the conversion to Medicare.

 

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National Kidney Registry -- Facilitating Living Donor Exchanges