*Purpose: Expose the need of an effective kidney paired exchange program in Mexico

*Methods: Describe how Pro-Renal works. Expose weaknesses of Mexican Health System. Compare our match results with those obtained by including the same pairs in the Alliance for Paired Kidney Donation (APKD) algorithm as an attempt to improve matching rates.

*Results: End stage renal disease patients in Mexico are increasing at an alarming rate. Average age of ESRD patients is 44.8±17.2 years. Access to renal replacement therapy is very limited (only 45% of the population) and carries a huge financial burden for patients and government. Health expenditure in Mexico is only 6.5% of the GNP. To date, more than 15000 patients are waiting for a kidney. There are only 2500 kidney transplants/year performed in the country. More than 60% of the kidneys come from living donors, so it is obvious to think that paired donation is a good alternative in Mexico. One third of wait-listed patients has a willing but incompatible donor. Since paired donation is not a common practice in the country, incompatible donors are sent home and the patient is added to the deceased donor waiting list. The Mexican Center Pro-Kidney Donation (Pro-Renal) is a nonprofit civil association created in 2016 with the help of the Alliance for Paired Kidney Donation. Our job is to generate transplant chains in Mexico, using the algorithm created by Dr. Alvin Roth and donated to us. So far we have more than 600 patients from all over the country in our database but only 40 of them have completed the transplant protocol and are able to participate in the program. Mean age of our patients is 41.2 years. Reasons for incomplete protocol include lack of access to medical facility with a Transplant Program, scarcity of tissue-typing labs and low-financial income. We ran the algorithm including the 40 pairs, and found only one match. We sent patient data to APKD (patient consent and full-disclosure agreements were obtained) and found 10 matches. This was only an attempt to improve our match numbers using a bigger donor pool. 32 patients (80%) are highly sensitized. None of the patients matched in the APKD algorithm have been transplanted.

*Conclusions: Strategies must be adopted to improve access to medical facilities capable of referring patients to transplant programs. Financial barriers are a problem for ESRD patients. No access to RRT (including transplant) is a death sentence.

World-wide, there is an organ shortage but kidney paired exchange helps reduce the waiting time for a kidney transplant, improving the quality of life and financial situation of our young patients.

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