Peggy needs a kidney donor

Kidney Paired Donation
Making Incompatible Donors Work

Kidney paired exchanges are becoming very common and an exciting option for kidney recipient and donor pairs who are not compatible with each other. Previously, people with kidney failure who had an incompatible donor were not able to benefit from the transplant being offered to them. However, kidney paired exchange programs are having a significant impact on the expanding options of living kidney transplants. Paired exchanges are now allowing transplants to occur between incompatible donor pairs and in a few unique ways.

How Does a Paired Kidney Exchange Work?

A kidney paired exchange consists of two or more donor/recipient pairs who are not compatible with each other. Kidney paired exchanges are a major breakthrough in living donations and are revolutionizing living donor transplants by eliminating incompatibility as a barrier to donation and providing a way for recipients and their incompatible donor to be paired with another incompatible recipient and donor.

Paired kidney exchange

In Pair 1, Donor 1 is not compatible with Recipient 1. In Pair 2, Donor 2 is not compatible with Recipient 2. However, Donor 1 is compatible with Recipient 2 and Donor 2 is compatible with Recipient 1. If you, your donor and the other pair are willing to participate in this “exchange,” a comprehensive evaluation process begins. The medical team will complete final medical tests and schedule the transplant on a date that works with everyone. Both transplants usually occur at the same day. This example used 2 pairs, but in fact any number of pairs is possible.


Domino Kidney Paired Exchange

A domino kidney paired exchange starts with a non-directed or altruistic donor. Instead of just one person benefiting from their donation, this donor can allow many incompatible pairs to be transplanted. The difference in the example shown below from the “Kidney Paired Exchange” is that Donor #2 is not compatible with either recipient #1 or #2. As such, the altruistic donor allows the other pairs to be exchanged, and have the domino effect.

Ongoing donor chains


Ongoing Donor Chains (Also called Never Ending Donor Chains)

Most recently, altruistic or non-directed donors have begun initiating donor chains which have the
potential to facilitate thousands of additional living donor transplants.

In the example below, donor, #2 does not donate in this exchange. Donor #2 is referred to as the
“bridge donor” for the next “chain”. Donor #2 functions in the same role as the altruistic donor in this
example. This chain could continue, over and over again with a new bridge donor.This example uses 2
pairs and the altruistic donor, but any number of pairs could be transplanted.

Ongoing donor chains


Compatible Paired Exchanges

Compatible donor/recipient pairs are being used to facilitate transplants with incompatible
donor/recipient pairs. This benefits the compatible donor/recipient pair if the recipient receives a
better HLA matched kidney, a kidney from a younger donor, or kidney that is a better size. The goal is
to have all recipients benefit by participating in such an exchange. An ideal compatible
donor/recipient pair is one where the donor is a blood type "O", and the potential recipient is blood
type "A", "B", or "AB".

Kidney Paired Exchange Programs

Many hospitals have their own kidney paired exchanges that they arrange within the incompatible
pairs at their hospitals. The nature of kidney paired exchanges is that the likelyhood of finding a
compatible pair is increased when there are many incompatible pairs. There are organizations that
“co-op” with other hospitals to increase the likelihood of being “matched” with another incompatible
pair. The following organizations have agreements with many hospitals in order to increase that

National Kidney Registry Contact: Joe Sinacore (201) 962-3186
The Alliance for Paired Donation Contact: Laurie Reece 512-961-6199
United Network for Organ Sharing Contact: Ruthanne Leishman 804-782-4770

Get in touch

Margaret Karbovanec


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