Barriers to implementing protocols for kidney paired donation and desensitization: survey of US transplant programs

Context - Special types of kidney transplant exist for patients who have willing but incompatible donors. Two types of transplants that circumvent donor-recipient incompatibility are kidney paired donation and desensitization. Lack of access to these protocols limits living donations and shortens the life span of patients with willing but incompatible donors. Objective - To understand potential barriers to implementing kidney paired donation and desensitization, as well as attitudes toward nondirected donation and compatible type 0 donation, which would maximize the number of kidney paired donation transplants performed via chains. Design - We created a 56-question Web-based survey to elicit information from US transplant program directors about 24 potential barriers to implementing these protocols. Participants - Of 166 programs contacted, 96 responded, including 88 complete and 8 partial responses. After pediatric-only programs and multiple responses from the same program were removed, 84 total (78 complete) remained. Main Outcome Measures - Respondents were asked to designate each barrier as major, minor, or not a barrier. Results - Availability of dedicated nurse coordinators and the United Network for Organ Sharing's variance request process (although kidney paired donation does not actually require a variance) were significant barriers to kidney paired donation. Most respondents (54%, 42/78) would prefer to participate in a regional rather than a national protocol for kidney paired donation. Risk of complications was the most significant barrier to desensitization. University affiliation, region, and training (nephrologist vs surgeon) had little effect on perception of barriers. Most (92%, 71/78) would evaluate nondirected donations; 53% (41/78) would encourage compatible type 0 donors to enter kidney paired donation. (Progress in Transplantation. 2010;20:357-365)