In kidney paired exchange, you have a donor willing to donate a kidney on your behalf, but you are incompatible with the donor or want to try to find a better match. With kidney paired exchange, your donor will donate their kidney to another recipient in exchange for a compatible kidney for you.
In the example at right, the first pair, a mother and her son, are incompatible. The second pair, a husband and his wife, are also incompatible. In this exchange, the mother donates to the wife of the second pair and the husband donates to the son in the first pair; this is called a loop.
Kidney paired exchange was originally created to overcome donor-recipient incompatibility; however, as a kidney patient with a compatible donor, you may want to participate in a paired exchange to find a donor who is a better match for you, while still allowing your donor to donate on your behalf. A better match usually means your transplanted kidney will last longer and you will require less immunosuppressive medication.
Typically, all of the surgeries in a paired exchange happen on the same day. A newer, more convenient option is the National Kidney Registry’s Standard Voucher Program, which is becoming more popular than traditional paired exchange because it allows the donor to schedule donation surgery at a time that is more convenient for them.
In addition to making donation easier for the donor, paired exchange through the NKR is generally better for transplant recipients. Despite facilitating transplants for more difficult cases, NKR transplants have better outcomes compared to the typical living donor transplant in the United States.