Kidney Paired Donation Transplant Program
People with kidney failure who find a willing donor whose blood type is not compatible would need to undergo treatments described in the Blood Type Incompatible Transplant portion of this website before they can receive a kidney. However, if a donor and recipient can be found who have the opposite blood type incompatibility, kidneys can be exchanged between the two pairs and two compatible live donor transplants are possible. This is called a Kidney Paired Donation Transplant. It can be very difficult for us to find a suitable exchange pair for certain blood types and most patients do end up having blood type incompatible transplants but, if desired, we will look for a suitable exchange pair.
What is Kidney Paired Donation?
Kidney Paired Donation is a program which assists donor/recipient pairs who are incompatible or poorly matched with each other to find another donor/recipient pair(s) with whom they can exchange kidneys to enable a more favorable compatibility and allow a transplant to take place.
Diagram 1
Who can participate in the KPD Program?
All medically eligible donor/recipient pairs may participate in the KPD program. Although, pairs will usually participate because the donor and recipient are incompatible due to blood type or tissue type, compatible pairs may participate, also.
Why would a compatible donor/recipient pair want to participate in the KPD?
Recipients with compatible donors have expressed an interest in participating in KPD programs for two reasons: (1) to find a younger or a 6 antigen (“perfect”) match donor, and (2) to selflessly aid the incompatible pairs in the KPD pool. It has been estimated that if compatible pairs entered the pool it would increase the number of transplants by 1000 in one year. Additionally, 45% of the compatible pairs could find a 6 antigen match or younger donor by entering the KPD program.
How many exchanges has Johns Hopkins performed?
To date (1/08), there have been 23 exchanges at Johns Hopkins and 54 patients have been transplanted.
When did Johns Hopkins start the Kidney Paired Donation Program?
The Kidney Paired Donation Program was started in 2001.
Why haven’t there been more exchanges performed?
It is difficult to arrange exchange transplants. Logistically, the center needs multiple operating rooms and teams of surgeons. All the participants must be readied for surgery at the same time. Many times, recipients are sensitized with tissue antibody and are difficult to match. Also, since the KPD program is not a national program, the individual transplant centers have small pools of patients making it difficult to identify matches. Hopefully, within the next 2 years, a national exchange program will be instituted in the U.S.
Do any other transplant centers in the U.S. perform exchange transplants?
Yes, there are a number of transplant centers who participate in regional exchange programs across the country. To date, there have been 251 patients transplanted in 27 states. Johns Hopkins has performed 54 of these transplants. (21%)
How are donor/recipient pairs matched-up?
Every donor and recipient who is interested in exchanging kidneys is entered into the database along with their HLA typing and blood type. The match program is run on a routine basis, approximately every 4 weeks, and potential matches are identified.
How do I know that another donor is a good as my own donor?
Every donor is evaluated according to standard medical practice. Each donor must go through a battery of tests and consults prior to being accepted into the program. Consideration is given to a matched age (within 10 years) between donors. Recipient/ donor pairs always have the option of declining offers.
How often is the match run?
The match program is run once a month.
How long does it take to find an exchange pair?
It can take anywhere from 1 month to 2 years to find an exchange pair.
1. Sensitization status of the recipient:
Some recipients develop tissue antibody as a result of exposure to foreign antigens. Antigens are substances that stimulate the production of antibody. Antigens include foreign blood cells from transfusions or pregnancies and cells from previous transplanted organs. It will take longer for a sensitized recipient to find a compatible kidney.
Sometimes a recipient will have numerous tissue antibodies which will make it very difficult to find a totally compatible donor. The match program will offer the best match possible. If this best matched exchange donor provides the recipient with a kidney that is much better than the match of his own donor but not totally compatible, a transplant may still be possible. In this case, the recipient could undergo a series of treatments to eliminate the low level of tissue antibody prior to the transplant. This is called desensitization.
2. Blood types of the donor/recipient pair.
If the recipient is of the ‘O’ blood type, they require an ‘O’ donor. ‘O’ donors are universal donors and can give to anyone. Therefore, the available ‘O’ donors in the KPD program are those that are unable to give to their recipient because the recipient is sensitized. Therefore, it will be more difficult to find a compatible donor for the sensitized recipient and the blood-type incompatible ‘O’ recipient.
3. Number of donor/recipient pairs in the database.
The more donors and recipients in the database the greater the chance of identifying an exchange pair.
Does Johns Hopkins share with any other transplant center ?
Yes, Johns Hopkins shares donor/recipient pairs with a number of regional programs in the U.S. In addition, we receive donor/recipient pairs from a number of other transplant centers to include in our database. This increases our pool of pairs and helps our patients get transplanted sooner.
Would the donors have to travel to the recipient center for their donation?
This depends on the recipient transplant center. Some transplant centers will ask the donor to travel to their center. In this case, the traveling donor will be assigned a coordinator, surgeon and nephrologist who will ensure that their needs are met. Some transplant centers will accept a donor’s kidney that has been shipped from their home transplant center. Research has shown that living donor kidneys that are stored in preservation fluid for up to eight hours work just as well as those kidneys with shorter cold storage. In the future, a National Kidney Paired Donation Program will allow the donors and recipients to indicate their wishes in this regard when registering for the program.
If I donate a kidney, how can I be sure my recipient will receive a kidney?
In the KPD program at Johns Hopkins, all donors go to the operating room at the same time to donate their kidney. Typically, the donors go to the OR first thing in the morning and then are followed by the recipients in the afternoon. There may be times when we exchange kidneys with another transplant center where the donor will be asked to donate their kidney a few weeks after the recipient is transplanted. In this situation, the recipient has already received his kidney.
How many pairs are involved in a KPD transplant?
This depends on the results of the match run. Johns Hopkins will try to optimize the number of transplants that can take place to help as many recipients as possible. Therefore, there could be a little as 2 pairs involved to as many as 5 or more pairs involved. If there are more than 3 pairs involved, it may be necessary to perform the transplants over a 2 day period.
Occasionally, there are those individuals who wish to donate a kidney to anyone who can benefit. These donors are called non-directed donors. Non-directed donors are placed in the Kidney Paired Donation database. The non-directed donor begins a domino exchange which allows a number of patients to be transplanted. The non-directed donors have been very happy to have helped more than one person through their donation. See Diagram 2.
Can the pairs meet?
Donor/ recipient pairs are kept anonymous until after the exchange has taken place. If all participants wish to meet or communicate with each other, this will be arranged by the transplant coordinator.
Has there been a time when someone did not get a kidney in an exchange because something went wrong during the exchange transplant?
This situation has not occurred at Johns Hopkins Hospital. You should be aware that the possibility exists that an event may occur in the operating room that deems it necessary to stop a donor procedure. In this case, one recipient would not receive a kidney. Also, if it was necessary to stop a recipient surgery, a kidney would be available. This kidney would then be distributed according to UNOS distribution policies and another recipient on the John Hopkins waiting list would be offered the kidney.
Do we have to sign a contract promising we won’t change our minds if we want to participate in the KPD program?
No, there is no binding contract to participants in the KPD program. You would have to sign a document that you agree to have your medical information shared with the recipient center where your kidney will be transplanted. This agreement would also allow Johns Hopkins to share your HLA tissue typing information with another KPD database so that we could try to find you a potential pair with whom to exchange. Your transplant coordinator will explain all aspects of the exchange to you and encourage you to ask whatever questions you might have. You will be asked to make a firm decision to participate so that logistics can be confirmed and there will not be a last minute change of mind.
Once we are in the database, what else do we have to do to stay active?
Every 6 months, you will receive a letter from the Transplant Office asking you for updated medical information, insurance information and demographic information. It is extremely important to notify the transplant office if your medical or living situation changes.
How do we know if there are any possible pairs identified who match us?
When a potential KPD pair is identified for you, both the donor and recipient will receive a tissue typing kit in the mail with blood tubes in it. There will be instructions with the kit that will tell you that a potential exchange pair has been identified and that you should have your blood drawn on the date specified in the letter. This blood is used to crossmatch you with the exchange donor/ recipient. You will be notified about 2 weeks later of the results of the crossmatch.
If I enter the KPD program, how do we find out if my donor and I are still in the database?
You can call your transplant coordinator at any time to confirm that you are still active.
Want more information?
Contact the Kidney Paired Donation Program Coordinator:
410-614-6074, option #1 or
888-908-5728
