Kidney PD is the best option for incompatible living donor (LD) pairs. However, the logistics of large swap procedures can be complex and time consuming. Utilizing computer-based matching & a streamlined process, the time from identifying pairs to actual surgeries can be minimized. At this center 16 PDs (11 2-way txps, 2 3-way, 2 4-way, & one 5-way txp on a single-day), have resulted in 41 kidney txps. We outline the process developed for use over a 5-wk period to facilitate up to 5-way single-day PD surgeries.
PD pairs are identified, their data entered into matching software and potential matches generated. MDs/RNs review pts medical suitability & virtual XMs. Desirable swap options are identified. Surgery date is set & OR times & rooms blocked. A grid is created to ID matched pairs & the XMs needed for each donor (incl back-ups in case of unexpected +ve XMs). Potential pairs are notified of proposed matches.
XMs completed. ORs are reserved and financial authorizations requested.
XM results reviewed & medical tests completed. Surgeons & OR times are assigned to each case. Pre-op H&P dates determined based on pts medical status, travel, & dialysis needs. Itineraries and final XMs are planned. Pts are contacted with details of final XMs, pre-op evaluations and surgeries. LD UNOS IDs are obtained. Color coded surgical logistics grid is created.
Final XMs are completed & reviewed. Final donor & recipient medical clearances are obtained. Multidisciplinary meeting with the OR, pre- & post-anesthesia unit, & ICU staff is held to discuss surgery day logistics.
Pre-op H&P & surgical consultations on each patient are completed. Multidisciplinary meeting held to discuss immunosupp & unique needs such as cardiac anesthesia. On the day of surgery LD coordinator familiar with all pts is available in the pre-anesthesia unit to facilitate pt flow.
Conclusion: This approach to scheduling PD surgeries shortens the time to txps and minimizes the potential for big swaps to fall apart, while concurrently creating alternatives should an unexpected +ve XM occur or a single pt get ruled out late in the process.
To cite this abstract in AMA style:Jaber L, John D, Ueda K, Bry W, Katznelson S, Peddi V. Paired Donation (PD) Problem Solving 101-A Single Center Protocol to Rapidly Facilitate Large Simultaneous Swaps [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/paired-donation-pd-problem-solving-101-a-single-center-protocol-to-rapidly-facilitate-large-simultaneous-swaps/. Accessed June 14, 2021.
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