*Purpose: The option of initiating a domino chain of living donor kidney transplants with a deceased donor (DD) has been proposed but never enforced. The DECK program (DECeased Kidney Paired Exchange) is created with the specific purpose of increasing the number and improving the results of domino-chains. In this program the chain-initiating kidney, selected from the pool of deceased donors, will be allocated to a recipient with an incompatible LD and, at the end of the domino-chain, the kidney oh the LD of the last pair will be transplanted into a waiting list’s patient.

*Methods: The gain of implementing the DEC-K program was measured with a specific algorithm, using retrospective data from the pool of incompatible pairs and deceased donors in a period of three years at Padua Transplant Center.

*Results: Starting from March 2018 to November 2019, 8 kidneys from a DD were used to initiate chains allowing to perform 23 kidney transplants, and enabling 15 incompatible pairs to receive and donate a kidney with no need for desensitization. Recipients of incompatible pairs were given priority in the allocation of chain initiating kidneys from DD only in the absence of urgent, highly sensitized or candidates to combined transplants. Nine Italian centers were involved either in procurement or transplant procedures. All donors are alive and with good renal function. Among the recipients no deaths occurred and only one graft was lost in the early post-operative period due to arterial thrombosis and it was a chain-ending kidney into a waiting list recipient. No cases of DGF are reported. Cold ischemia time was on average less than 7 hours and mean serum creatinine at discharge was 1.4±0.7 mg/dL. The 8 chain-ending kidneys were allocated to sensitized patient on the waiting list and their mean time on list was 8 years.

*Conclusions: After appropriate management of the ethical, allocation and logistic issues, Kidney Paired Donation Programs starting with DD kidneys turned out to be feasible. DECK program achieved 23 transplants in 20 months, almost tripling the original potential source of 8 deceased donors. The major advantage of the DEC-K program is to offer an opportunity of a transplant for recipient of incompatible pairs but it can also benefit the waiting list’s patients allocating chain-ending kidney from living donor to them, prioritizing patients sensitized and long waiter for immunological reasons.

« Back to 2020 American Transplant Congress