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Why Paired Kidney Exchange is the Best Option for Living Kidney Donation

Kari Rancourt, Living Donor Transplant Coordinator, Hartford Hospital

Paired kidney exchange, also known as a kidney swap or kidney paired donation (KPD), is a type of living kidney donation that allows a kidney transplant recipient with a willing donor to receive a compatible organ through an exchange with another donor-recipient pair. It can involve one or multiple pairs of donors and recipients who are incompatible with their intended recipients but compatible with other pairs in the exchange.

Paired kidney exchange was originally created to overcome donor-recipient incompatibility; however, compatible pairs are increasingly choosing to participate in paired exchange to find a better kidney match for the recipient. With paired kidney exchange, one donor’s kidney donation goes to a recipient for whom they are an excellent match, while that donor’s intended recipient receives a kidney donated by a different donor who is a better match for them than their intended donor.

While there are emotional reasons why a donor might want their kidney to be the one transplanted into their intended recipient, there are many reasons why paired exchange is a better option:

Paired kidney exchange can overcome incompatibility issues. Paired kidney exchange enables transplant candidates who have willing but incompatible donors to still receive a compatible kidney. In traditional kidney transplantation, the donor and the recipient had to be compatible to prevent the recipient’s body from rejecting the donor’s kidney. With paired exchange, incompatibility no longer matters. As long as an individual is healthy enough to donate, there is a safe and effective option regardless of compatibility.

Paired kidney exchange increases transplant opportunities. Paired kidney exchange programs, such as the one offered by the National Kidney Registry (NKR), create more transplant opportunities by enabling potential living donors who are incompatible with their intended recipients to still become donors. By participating in an exchange, these donors can help other recipients in need of a kidney while still ensuring a compatible living donor transplant for their intended recipient. Someone can only donate their kidney once; using an exchange allows that one donation to have the biggest possible impact.

Paired kidney exchange reduces wait times. Paired kidney exchange can significantly reduce the amount of time a kidney patient must wait for a compatible kidney to become available. Kidney patients on the waitlist for a kidney from a deceased donor can wait up to 10 years due to the scarcity of organs. With the NKR’s paired kidney exchange program, the typical wait time for a kidney patient to find a matching kidney from a living donor is 90 days.

Paired kidney exchange increases overall transplantation rates. Paired exchange facilitates more transplants, thereby increasing the overall transplantation rate. This allows more individuals with end-stage kidney disease to receive a life-saving transplant and improves their quality of life and long-term outcome.

Paired kidney exchange can provide a better match. Even if a donor and recipient pair are compatible, paired exchange can offer the opportunity to find an even better match based on age, kidney size or immunology. When recipients are matched with the best donor for them, they have the best chance of their transplant lasting as long as possible.

Paired kidney exchange minimizes immune system complications. When the donor and recipient are not well matched, the recipient’s immune system may recognize the transplanted organ as foreign and mount an immune response, leading to organ rejection. Paired exchange results in better matches and a lower chance of immune-related complications. Depending on the quality of the kidney donor match, the transplant recipient may even be able to reduce their dosage of immunosuppressive medications.

Paired kidney exchange enhances donor satisfaction. Paired kidney exchange programs offer a unique opportunity for living donors to help their loved ones or others in need and provide a sense of fulfillment for donors who may not have been able to directly donate to their intended recipients. Knowing that their donation has helped not only their intended recipient but also another person in need of a transplant (or several, if the paired donation is part of a kidney donation chain) makes the donation experience even more emotionally rewarding.

Paired kidney exchange provides additional donor protections. The National Kidney Registry’s Donor Shield program provides comprehensive protections and assistance for living donors who donate through paired exchange, including reimbursement for lost wages and expenses for travel and dependent care, as well as prioritization for a living donor kidney in the extremely unlikely case they ever need a transplant in the future. For more information on Donor Shield, visit www.donor-shield.org.

Paired kidney exchange allows donors to donate on their timeframe. A donor may have very specific time restrictions that might not align with the needs of the transplant candidate. Kidney exchange allows a donor to have surgery when it is convenient for them while also enabling their intended recipient to be prioritized for matching when they are ready for transplant.

Paired kidney exchange provides support. Sometimes the donor and recipient may be the only people available to care for each other after surgery. By using the NKR’s Voucher Program, many pairs are able to act as each other’s support person during recovery.

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