*Purpose: Compatible donor (CD) and living non-directed (altruistic) donor (NDD) participation in kidney paired exchange programs has been known to increase the transplantation possibilities for incompatible pairs.

*Methods: In our single-center paired exchange program we enrolled: Compatible pairs defined as a donor and recipient who are ABO compatible and HLA crossmatch negative and elect to participate in paired exchange either to find a better organ, a better match, or for altruistic reasons and Living non-directed kidney donors who choose to donate a kidney for altruistic reasons in the hopes of facilitating live-donor transplantation. Records from Jan 2007 to Nov 2018 were reviewed to evaluate the impact of CD and NDD participation on transplantation for incompatible pairs.

*Results: During this time period 728 living donor transplants were performed of which 153 (21%) transplants were the result of paired exchange transplants (compatible and incompatible pairs). 12 compatible pairs participated in 12 paired exchanges that resulted in a total of 43 transplants. The 12 paired exchanges included one 5-way; seven 4-way; two 3-way; and two 2-way exchanges. The 12 compatible pairs included 11 living-unrelated and one living-related pair (donor was 65 yr old mother and recipient was 35 yr old son). Five compatible pairs entered paired exchange to receive a kidney with age or body size advantage, one with low-grade DSA but crossmatch negative to receive a kidney from donor with no DSA, and six for altruistic reasons. Blood groups of the 12 compatible donors included 11 with O and 1 with A blood group. During this same period 17 NDD who participated in paired exchange included 7 in a national paired exchange program and 10 in the local paired exchange program at this center. Participation of the 10 NDD made an additional 49 transplants (include incompatible pair recipients and recipients on the deceased donor list that end a chain) possible.

*Conclusions: Participation of CD and NDD enrich paired exchange and greatly benefit both compatible and incompatible recipients even at a single center level.

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