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What is a paired kidney exchange?

It’s often difficult for people in need of a kidney transplant to find compatible donors, but paired kidney exchanges are helping bridge the gap. Two University of Minnesota Health experts explain.
What is a paired kidney exchange, and how is it helping people in need of a kidney transplant find compatible organ donors? University of Minnesota Health Transplant Surgeon Ty Dunn, MD, and Transplant Coordinator Margaret Voges, RN, BAN, took time to explain the concept.
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Anyone who has tried to donate a kidney to a friend or relative can tell you: It’s often a lengthy process, and there’s no guarantee in the end that you will be a “match” with the intended recipient.

Sometimes incompatible blood types prevent a willing and medically able donor from giving a kidney to a family member or friend. Many other issues can also affect a donor’s compatibility, according to Transplant Surgeon Ty Dunn, MD, the surgical director for the University of Minnesota Health living donor kidney program.

To overcome those problems, an increasing number of kidney donors and recipients are turning to paired kidney exchange. So what is a paired kidney exchange?

A paired exchange allows would-be recipients with willing yet incompatible donors—like a spouse or brother—to match up with other donor-recipient pairs in the same situation. After two pairs are matched with each other, they “swap” kidneys, with each donor giving to the other recipient in the other pair.

“The paired exchange program increases the possibility that a person can find a match for a living donor kidney transplant. It offers the best long-term outcome for patients and gives them the chance to get off dialysis sooner,” Dunn said.

Started in 2009, the University of Minnesota Health paired exchange program continues to expand. Between 2015 and 2016, the number of paired kidney exchanges doubled, from 13 to 26 paired exchange donations. Growing exposure and awareness of this donation option has largely driven the increase.

Learn more about University of Minnesota Health organ transplant care.

Paired kidney exchanges, sometimes started by altruistic donors—those giving without an intended recipient—have also helped create kidney donation “chains” between transplant centers across the nation. Coordinated by the National Kidney Registry, these transplant chains connect a long network of individual donor-recipient pairs, thus giving people in need of a kidney transplant more options.

In 2015, Kathy Hart, an altruistic donor at University of Minnesota Medical Center, helped set off one of the longest kidney donation chains to date. Hart’s donation helped 36 people nationwide receive a kidney.

Though the paired exchange program and donation chains give people who have found a donor a second chance at getting a viable live kidney, it’s not always an easy choice for all involved, according to Margaret Voges, RN, BAN, a transplant coordinator for the program.

Some donors may have concerns at first about giving a kidney to a complete stranger, instead of their intended friend or loved one, Voges said. Others are often uncertain about giving away their kidney without first securing an organ for their partner.

Voges works with donors and recipients to address their concerns. In all cases, donations and chains do not move forward until every recipient involved is matched with a donor.

Kidney pairing is still relatively new, but Voges and Dunn are optimistic. They believe with time and awareness the program and donor pool will grow so that more people can receive kidneys from living donors. Living donations are generally preferable to donations from deceased donors because of the health of the organ.

Learn more about living donor kidney transplants.

“As more patients start to realize this is a viable option, we’ll have more chances to connect people in need with donor kidneys,” Voges said. “The larger the pool grows, the easier it’ll become to find matches.”

“We’ve focused on making sure donors and recipients understand all of their options, so that a paired kidney exchange is not just an afterthought,” Dunn said. “Potential donors need to be healthy and have excellent kidney function,” Dunn said. “Paired kidney exchange allows one willing and able person to make all the difference for someone in need of a kidney transplant, no matter the actual match.”

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