Kidney Matching Tips

  1. When entering patient avoids, include all low-level Donor Specific Antibodies (DSAs).
    1. By entering all DSAs, the patient will have a more accurate cPRA, increasing their matching priority in the NKR.
    2. By entering all DSAs, you will increase the odds that NKR will find a better matching donor for your patient.
    3. By entering all DSAs, you will reduce the risk of a swap failure caused by unexpected unacceptable XMs.
  2. If you patient has an NKR cPRA > 99% (hard to match), use the “Avoid Conflict” tab in the pre-select screen to find additional matching donors.
    1. Review all potential donors with one or more avoid conflicts in the Avoid Conflict tab.
    2. Override avoid conflicts by accepting donors with low level DSAs that, in combination with other DSAs, will not cause an unacceptable XM.
    3. Request cryo cells and perform rapid exploratory XMs on those borderline donors where the XM results are not predictable.
  3. Center Liquidity Contribution (CLC): Centers that enter “O” NDDs and ABO favorable pairs (“O” donors with “A”, “B”, or “AB” recipients) will receive CLC points which will prioritize the patients at that center. A positive CLC score has the greatest impact on shortening wait times for pairs with unfavorable blood type combinations (“O” recipients with “A”, “B”, or “AB” donors).
  4. Multiple Paired Donors: Many centers have unfavorable blood type combination that wait a long time for a match offer. If your patient has another donor, you can increase their odds of receiving a match offer by entering the second donor into NKR but the most powerful way to get these patients transplanted is for the center to achieve a positive CLC score.
  5. One criterion that is used to prioritize potential matches is wait time. Wait time is accrued for days that the pair is “exportable” and is NOT based on registration date. The sooner a center can make a pair exportable and the longer the pair remains exportable, the more wait time the pair will accrue.
  6. Abundant A2 donors: If you have an “O” recipient with titers acceptable for an A2 donor, you can generally get an immediate match if you set the patient filed to allow for A2 donor matches.
  7. Many donors are declined on anatomy, blocking potential matches. In some cases, these declines can be overcome by offering the other kidney which may not exhibit complex anatomy. This can be accomplished by selecting the appropriated options in the donor record.
  8. Compatible pairs: An A, B or AB patient with a compatible O donor will find a match immediately and can afford to be very selective when accepting potential donors while other compatible pair blood type combinations (e.g. O to O, A to A, etc.) may not be matched as quickly and therefor may have longer KPD wait times.
  9. The NKR can improve the donor-recipient match for compatible pairs which can improve patient outcomes while facilitating transplants for many other incompatible pairs. See Finding the Best Match to learn more.
  10. Centers should consider using charter flights to ship kidneys when no direct flights are available. An analysis of transport options showed that for a nominal 18% average increase in costs for a charter compared to an on-board courier, transit times are reduced from an average of 11 hours to less than 5 hours.
  11. If you have a patient that has not received a match offer and you are wondering if there is an issue with the paired donor that is causing centers to decline the donor, look at the declines tab in the donor profile. This tab provides an accounting of the donor declines and the reasons for each decline.
  12. Adequate Surgical Capacity Will Help Your Patients Get Matched & Transplanted – NDDs and compatible pairs often have tight timeframes for surgery, limiting swap scheduling options. Many patients that are matched in FAST TRACK swaps are losing out on transplant opportunities due to the lack of surgical capacity at some centers. Centers can get more patients transplanted by increasing surgical capacity by
    1. Coordinating surgeon vacation/travel schedules to ensure coverage on NKR target swap days, which are Tuesday, Wednesday and Thursday.
    2. Cross-training donor and recipient surgeons so that one surgeon can do both surgeries.
    3. Hiring more surgeons.
  13. Desensitization
    1. If your patient has an NKR cPRA of 99% or less and all DSAs have been listed as avoids so that the cPRA is accurate, this patient should not require desensitization and should be matched/transplanted in 6-12 months.
    2. If your patient has an NKR cPRA of 100%, they will likely require desensitization to get matched/transplanted in the NKR.
    3. If your patient has an NKR cPRA of 99% – 100% and they have been waiting more than a year for an NKR match, they may require desensitization to get matched/transplanted in the NKR.