Paired Exchange
Figure 1: In paired exchange, a donor/ recipient pair (such as a mother and son that don't have compatible blood types) are matched with another donor/recipient pair(s) for a "swap". Each donor gives a kidney to the other person's intended recipient.

Kidney paired donation is a new approach for offering living donor kidney transplants to recipients who are incompatible with their recipient, or the pair has better match options with another pair in the program.

Paired exchange donation consists of two or more kidney donor/recipient pairs. The recipients trade donors so that each recipient can receive a kidney that best matches them. Once all donors and recipients have been tested, the kidney transplant surgeries can be scheduled to occur simultaneously.

Two Types of Paired Donation Programs

Incompatible Paired Donation Program: Recipients may have a willing living donor that cannot donate because they are not a match due to incompatible blood types or to recipient antibodies. A recipient/donor pair that is willing to participate in this program would be placed in a database to potentially find another recipient/donor pair that could be a compatible match for each other. (Figure 1)

Another example of an incompatible paired donation is the NEAD Chain. The acronym NEAD stands for never-ending altruistic donor chain where potential donors are matched within a much greater pool of recipients and donors. (Figure 2)

Compatible Paired Donation Program: Another type of exchange program involves exchanging recipient/donor pairs that are compatible, meaning they are not sensitized and have compatible blood types. Research has shown that the age of the donor kidney is a strong predictor of long term kidney function. This kidney paired donor exchange program offers patients with older compatible kidney donors the opportunity to exchange donors with recipients that have a younger donor who is not compatible with them. (Figure 3)

Figure 2: In this example, a recipient has a chance to receive a kidney from a younger donor while the other recipient with an incompatible donor is able to receive a living donor kidney transplant from a compatible donor.

Increased Number of Paired Donors

The number of paired donation transplant has increased exponentially, from two in 2000 to 429 in 2011 (Figure 4). With the development of donor chain transplants, and with a national system for paired donation, the number will hopefully continue to grow.

The University of Utah Kidney Transplant Program has developed a paired donation program (in cooperation with location and national registries) allowing a recipient-donor pairs to exchange kidneys with other pairs.

If you are interested in being a paired donor, please contact our living donor coordinator at (801) 585-3202 regarding the paired donation program.

If you would like to know more information about the paired donation program, please visit the National Kidney Registry.