Paired Donations Increase Scrutiny of Issues

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Kidneys are the most commonly transplanted organ, and now with the advent of transplant chains that use several sets of matched pairs, the numbers of these logistically challenging operations are poised to rise to levels unanticipated only a few years ago. At the same time, increased scrutiny of chain transplants, which rely on living donors, is emerging from all corners of the industry.

A recent conference of national and regional kidney transplant partners represented a first attempt to agree on the direction of their field. Insurers and representatives from several registries and the large federally run United Network for Organ Sharing (UNOS) also attended. UNOS manages the national transplant waiting list and maintains the database that has all organ transplant data, from every transplant that happens in the United States.

Held in late March in Herndon, VA, the Consensus Conference on Kidney Paired Donation had an ambitious goal—to seek consensus among the 70 participants on ways to increase the volume of transplants that involve kidney paired donation (KPD). The genesis of the conference was the idea that KPD is the most effective approach to recruit a substantial pool of high-quality kidneys from healthy living donors. These donors would not have volunteered otherwise because their kidneys weren’t a compatible match for their family member or loved one. Despite the need and opportunities for this type of donation, KPD remains an often unused option.

An announcement from the University of California, San Francisco—where the conference’s lead organizer Sandy Feng, MD, PhD, is a transplant surgeon—described the first consensus meeting and noted that “the emergence of multiple KPD programs with diverse approaches and processes attests to a lack of consensus as to how to maximize the benefit and minimize the risk of KPD.”

While the participants expressed a desire for a unified registry that would provide a centralized system for storing and accessing data about donors and recipients, they ultimately could not agree over how this unifying effort would take place, according to Kevin Sack, who reported on the conference for The New York Times.

One mathematician from the U.S. Naval Academy, Sommer Gentry, who had been working on donation models, wanted to eliminate barrierss to a national registry. “With two pools of 100, you get fewer opportunities than with one pool of 200,” to match donors to recipients.

Sack noted that Feng was concerned that unifying all of the current registries into one system might stifle the innovations used by successful registries like the National Kidney Registry. “Maybe we can have different operations with common allocation methods and principles, [without complete unification of systems],” Feng said.