Journal
AMERICAN JOURNAL OF TRANSPLANTATION
Volume 11, Issue 5, Pages 984-994Publisher
WILEY-BLACKWELL
DOI: 10.1111/j.1600-6143.2011.03481.x
Keywords
ABO incompatibility; allosensitization; paired kidney exchange; regional sharing; simulation models; transplantation policy
Categories
Funding
- Alliance for Paired Donation
- Life Connection of Ohio
- University of Toledo
- National Science Foundation [0616733]
- Novartis
- Genzyme
- Astelles
- Roche
- Wyeth
- Pfizer Pharmaceuticals
- Direct For Social, Behav & Economic Scie
- Divn Of Social and Economic Sciences [0616733] Funding Source: National Science Foundation
- Divn Of Social and Economic Sciences
- Direct For Social, Behav & Economic Scie [1061889] Funding Source: National Science Foundation
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Since 2008, kidney exchange in America has grown in part from the incorporation of nondirected donors in transplant chains rather than simple exchanges. It is controversial whether these chains should be performed simultaneously 'domino-paired donation', (DPD) or nonsimultaneously 'nonsimultaneous extended altruistic donor, chains (NEAD). NEAD chains create 'bridge donors' whose incompatible recipients receive kidneys before the bridge donor donates, and so risk reneging by bridge donors, but offer the opportunity to create more transplants by overcoming logistical barriers inherent in simultaneous chains. Gentry et al. simulated whether DPD or NEAD chains would produce more transplants when chain segment length was limited to three transplants, and reported that DPD performed at least as well as NEAD chains. As this finding contrasts with the experience of several groups involved in kidney-paired donation, we performed simulations that allowed for longer chain segments and used actual patient data from the Alliance for Paired Donation. When chain segments of 4-6 transplants are allowed in the simulations, NEAD chains produce more transplants than DPD. Our simulations showed not only more transplants as chain length increased, but also that NEAD chains produced more transplants for highly sensitized and blood type O recipients.
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