*Purpose: A kidney paired donation pool (KPDP) consists of transplant candidates and their incompatible living donors along with nondirected living donors (NDDs). In a match run, exchanges are arranged among pairs in the pool via cycles or chains stemming from NDDs. By simulations, we evaluate strategies to utilize deceased donors (DDs) as NDDs to begin a chain the final donor of which would give back to the DD waitlist.

*Methods: We compare two strategies: “KPD only” corresponds to the usual sequence of match runs, taken every 10 days, and transplanting of viable chains and cycles; “KPD&DD” adds DDs as NDDs to the KPD allowing chains of length 2 in which the DD gives to a candidate in the KPDP, and that candidate’s donor gives to the DD waitlist. The simulations take account of probabilities that chosen transplants may not be completed and allow for fallbacks when plans fail. We use data on pairs and NDDs from the Alliance for Paired Donation. The actual sequence of arrivals of DDs during 2015 were used in the simulation and we diverted to the KPDP at most one kidney from each deceased donor with KDPI between 21 and 35%. Our simulation varied initial KPDP size (400, 800), pair arrivals (1, 2/day), NDD arrivals (1, 3, 5/month), wait time of each new KPD pair until eligibility for a DD transplant (0,1,3 months). During a candidate’s wait time, he or she can only be transplanted via a KPDP match run. Match runs in the KPDP occur every 10 days.

*Results: . We found that, compared to KPD only, including DDs (KPD&DD) increased the average number of transplants in one year by 260 to 573. Selected results are shown in Table 1, where the initial KPDP size is 400 and the NDD arrival rate is 1/month. Increasing the wait time results in fewer transplants but also diverts fewer DDs to the KPDP, and as expected, doubling the arrival rate substantially increases the number of transplants under both strategies. Note that any accepted DD offer in the KPD results in a living donor offer to the DD waitlist, so the number of offers to the waitlist is the same under either strategy. Across all simulations, the number of NDDs had only a small effect in KPD&DD. In KPD&DD, each diverted blood type O DD gives rise to about 1.2 transplants of O candidates, 1.0 in the KPDP and 0.2 in the waitlist.

*Conclusions: . We address some policy issues with implementation. We also report on some extension to allow DDs to create longer chains, and note possible variations on this theme. We also note that KPD&DD could play a substantial role in addressing the aim to increase transplantation in the Advancing American Kidney Health Initiative.

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