Deceased Donor-Initiated Non-Simultaneous Extended Altruistic Donor Chains Through the Military Share Program.

M. Rees,^1,2 O. Ekwenna,¹ E. Elster,³ A. Patel,³ D. Murtagh, Jr,¹ A. Roth,⁴ K. Krawiec,⁵ J. Arrington,⁶ I. Ashlagi,⁴ J. Hawksworth.³

¹U Toledo, Toledo, OH
²Alliance for Paired Donation, Perrysburg, OH
³Walter Reed National Medical Center, Bethesda, MD
⁴Stanford U, Palo Alto, CA
⁵Duke U, Durham, NC
⁶Buckeye Transplant, Findlay, OH

Meeting: 2017 American Transplant Congress

Abstract number: D279

Keywords: Allocation, Donation, Ethics, Waiting lists

Session Information

Session Name: Poster Session D: Non-Organ Specific: Economics, Public Policy, Allocation, Ethics

Session Type: Poster Session

Date: Tuesday, May 2, 2017

Session Time: 6:00pm-7:00pm

Presentation Time: 6:00pm-7:00pm

Location: Hall D1

Introduction: At a recent White House Summit on organ transplantation, the Department of Defense (DoD) announced that they would direct some Military Share deceased donor kidneys (MSDDK) to initiate nonsimultaneous extended altruistic donor (NEAD) chains.

Methods: To study MSDDK-initiated NEAD (MSDDKIN) chains, we simulated match runs using actual data from a large national kidney exchange program and actual data from 15 Military Share donors from Jan 1, 2016 through August 1^st, 2016.

Results: In actual experience, each of the 15 MSDDK were allocated to a single patient at Walter Reed National Medical Center and provided 15 kidney transplants for patients on the DoD deceased donor waiting list with the following blood type (BT): 7 BT-O, 7 BT-A, and 1 BT-B. The BT of the actual recipients was identical to the BT of the MSDDK. In the simulation attempting to create NEAD chains initiated with the same the 15 MSDDK, 11 MSDDKIN-chains were possible using an algorithm that identified the optimal solution allowing unlimited length cycles and chains. Of the 11 MSDDKIN-chains, all of them allowed 2-way, 3-way or longer chains to be formed. The longest chain that could be formed identified 16 potential transplants. Had all MSDDKIN-chains achieved the maximum length chain identified, a total of 89 transplants could have been produced from 11 MSDDK (8.1 transplants/MSDDK). The blood type of the 78 MSDDKIN-recipients (not including chain-ending recipients to be returned to the DoD) were BT-O in 36, BT-A in 26, BT-B in 6 and BT-AB in 10. Of the 78 MSDDKIN-recipients (not including chain-ending recipients), 29 had a PRA of 0%, 23 had a PRA of 20-79% and 26 had a PRA of >80%. The 11 chain-ending kidneys returned to the DoD had the following blood types: 1 was BT-O and 10 were BT-A.

Conclusion: MSDDKIN-chains have the potential to significantly increase the total number of transplants achieved per deceased donor kidney and provide increased opportunities for transplantation for ESRD patients of all blood types and levels of sensitization.

CITATION INFORMATION: Rees M, Ekwenna O, Elster E, Patel A, Murtagh, Jr D, Roth A, Krawiec K, Arrington J, Ashlagi I, Hawksworth J. Deceased Donor-Initiated Non-Simultaneous Extended Altruistic Donor Chains Through the Military Share Program. Am J Transplant. 2017;17 (suppl 3).

To cite this abstract in AMA style:

Rees M, Ekwenna O, Elster E, Patel A, Murtagh D, Roth A, Krawiec K, Arrington J, Ashlagi I, Hawksworth J. Deceased Donor-Initiated Non-Simultaneous Extended Altruistic Donor Chains Through the Military Share Program. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/deceased-donor-initiated-non-simultaneous-extended-altruistic-donor-chains-through-the-military-share-program/. Accessed May 13, 2025.

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