Across the globe, numerous kidney transplant candidates and donors are linking up in often complicated ways to facilitate more transplants through exchange programs, or swaps. The largest swap so far, which was orchestrated by the National Kidney Registry (NKR) and involved 60 lives and 30 kidneys, was described recently in The New York Times (http://www.nytimes.com/2012/02/19/health/lives-forever-linked-through-kidney-transplant-chain-124.html?_r=2). Also, in early February the NKR announced that it had facilitated its 400th exchange transplant. These efforts by the NKR and other programs could not come at a better time. Nearly 90,000 people in the United States are waiting for a kidney transplant, and many will die before a suitable organ becomes available. The shortage is expected to worsen.
Such living donor chains and simpler closed-loop paired exchanges, which involve two pairs of donors and recipients, assume that kidneys from living donors are of comparable quality and anticipated longevity. But how true is this assumption? Potential recipients often wonder, will the kidney received from a stranger—particularly an older one—be as good as a kidney donated by a loved one?
“In a proposed kidney paired donation match, if an old donor–recipient pair is matched to a young donor–recipient pair, the young recipient may feel disadvantaged and may not be willing to trade with an older donor,” said Paolo Ferrari, MD, director of Australia’s national registry for paired kidney exchanges. “Refusal to participate in an exchange could break the chain of potential matches identified after a match run and could limit the success of a kidney paired donation program.”
A recent study by John Gill, MD, and his colleagues, of the University of British Columbia, in Vancouver, Canada, that appears in the Clinical Journal of the American Society of Nephrology investigates this issue. The researchers analyzed the survival of kidneys from donors of different age groups that were transplanted into recipients of different age groups. Their study included data from all adult kidney transplants from living donors that were performed in the United States from January 1988 to December 2003, with follow-up through September 2007.
Study co-authors include Peter Chang, MD, Jagbir Gill, MD, James Dong, Caren Rose, Howard Yan, MD, David Landsberg, MD (University of British Columbia, in Vancouver, Canada); and Edward Cole, MD (University of Toronto, in Canada).
The article “Living donor age and kidney allograft half-life: implications for living donor paired exchange programs,” appeared online at http://cjasn.asnjournals.org/ in March 2012, doi: 10.2215/CJN.09990911.