Back in 1997, the Sounding Board from The New England Journal of Medicine proposed a new approach to increasing the number of kidneys available for transplant: using kidneys from living donors who are incompatible with the intended recipients but are compatible with other recipients.
For example, my brother Arnie wants to give me one of his kidneys, but he is ABO incompatible. My friend Max on dialysis has a potential donor Belinda in the same position. After testing, we find that Belinda is compatible with me and Arnie is compatible with Max. A match made in heaven! Belinda donates her kidney to me and Arnie gives his Max. The government likes the idea and the Paired Kidney Exchange (KPE) program is born.
In various forms, this program has been around since the late ‘90s. Many US transplant centers participate in regional exchange programs across the US. Johns Hopkins set up their program in 2001. To Jan 2008, there have been 251 patients in PKE programs transplanted in 27 states across the US.
The first national approach to PKE was the Dutch National Living Donor Kidney Exchange Program, set up in June 2004. All Dutch kidney transplantation centres agreed on a common protocol. An independent organization is responsible for the allocation, cross matches are centrally performed and exchange takes place on an anonymous basis. Donors travel to the recipient centers. Surgical procedures are scheduled simultaneously. Sixty pairs participated within 1 year. A compatible pair was found for 9 of 29 ABO blood type incompatible and 17 of 31 cross match positive combinations. Five times a cross match positive couple was matched to a blood type incompatible one, where the recipients were of blood type O. The program has been very successful helping to reduce transplant waiting lists.
Australia has taken its time to get with the program. The exchange of kidneys was illegal in all Australian states except Western Australia, until June this year, when Professor Paolo Ferrari became the first National Clinical Lead of the National Paired Kidney Exchange program for the Australian Organ and Tissue Donation and Transplantation Authority.
WA led the way with the WA Kidney Exchange Program legislation in 2007. The first Australian paired kidney transplant was performed in Perth in November 08. So far there have been 11 successful transplants. Just last Thursday, Australia’s first kidney swap between families took place in Perth, with four simultaneous operations over seven hours at Sir Charles Gairdner and Royal Perth Hospitals.
Last year there were just 812 kidney transplants in Australia, 459 from deceased donors and 353 from live donors. The national PKE program has the potential to lift the live donor numbers by up to 200 additional transplants per year. Transplants for you and me.
The way I see it there are three places to start:
- The Australian Organ and Tissue Donation and Transplantation Authority puts up an Online Donor Matching website, where donor recipient pairs can meet, exchange info and kick off the process. (Sending some emails to the Authority suggesting they get started may be useful.)
- If you have had someone offer a kidney to you, but have been found to be incompatible, tell them about this new program.
- Raise the program with your nephrologist: ask about getting on to the program, its availability, and your options during your next visit.
You never know, you may be moving from the BigD to the BigT sooner than you expect!