Reciprocity for Compatible Pair Participation in Kidney Paired Donation.
1Nephrology, UBC, Vancouver, BC, Canada
2Nephrology, CHUM, Montreal, QC, Canada
3Nephrology, UHN, Toronto, ON, Canada.
Meeting: 2016 American Transplant Congress
Abstract number: 423
Keywords: Donors, Ethics, Kidney transplantation, Public policy, unrelated
Session Information
Date: Tuesday, June 14, 2016
Session Name: Concurrent Session: Kidney Paired Exchange: Outcomes and Issues
Session Time: 2:30pm-4:00pm
Presentation Time: 3:18pm-3:30pm
Location: Ballroom C
Participation of ABO and HLA compatible pairs (CPs) in kidney paired donation (KPD) could significantly increase living donor (LD) transplantation (TX). CPs may be more likely to participate in KPD if there was some benefit. Potential benefits include a younger or better HLA matching donor, but only a minority of CPs will derive these benefits and benefits cannot be assured a priori. In contrast, providing the compatible recipient with priority for subsequent deceased donor TX in the event of primary transplant failure (reciprocity for KPD participation) is a tangible benefit that may encourage participation.
We estimated the impact of reciprocity on overall TX. SRTR data on ABO and HLA compatible LD transplants between 2000-2011 and published information regarding the proportion of incompatible pairs and CPs that would match in a national KPD program were used to determine the overall percent increase in TX by discounting the number of CP recipients who would require wait-list priority after failure of a primary LD transplant from the projected increase in LD TX facilitated by the participation of CPs.
Because a minority of CPs will develop primary LD transplant failure and require wait-list prioritization for a subsequent deceased donor transplant (table), reciprocity strategies (3,4) provided a greater % increase in transplantation compared to limiting KPD participation to incompatible pairs (strategy 1), or a strategy that limited CP participation to pairs that matched to a younger or better HLA matching donor but provided no wait-list priority for CPs (Strategy 2).
Conclusion: Reciprocity strategies could significantly increase transplantation and will be further evaluated in the context of the Canadian kidney paired donation program.
| Strategy | % of incompatible pairs matched | % of CP requiring WL Priority | % increase in overall transplantation |
| 1. Only incompatible pairs in KPD | 37% | 0% | reference |
| 2. Only CPs that match to a younger of better HLA matched donor in KPD. No wait-list priority provided for CP participation in KPD | 69% | 0% | 84% |
| 3. Include all CPs in KPD but wait-list priority given only to CPs with transplant failure who matched in KPD and did not receive a younger or better HLA matched donor. | 75% | 3% | 94% |
| 4. Include and prioritize all CPs with transplant failure irrespective of whether they matched in KPD or received a younger or better HLA matched donor | 75% | 12% | 88% |
CITATION INFORMATION: Gill J, Fortin M.-C, Rose C, Cole E, Tinckam K, Gill J. Reciprocity for Compatible Pair Participation in Kidney Paired Donation. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Gill J, Fortin M-C, Rose C, Cole E, Tinckam K, Gill J. Reciprocity for Compatible Pair Participation in Kidney Paired Donation. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/reciprocity-for-compatible-pair-participation-in-kidney-paired-donation/. Accessed April 2, 2020.« Back to 2016 American Transplant Congress