Progress towards a sensibly organized national kidney exchange

An important story has played out one more quite positive step in the dry prose of medical bureaucracy, in the form of a report of the Policy Oversight Committee of the Organ Procurement and Transplantation Network (OPTN) of the Health Resources and Services Administration (HRSA). (All of the reports are found here.)

The report in question is this one, OPTN/UNOS Policy Oversight Committee, Report to the Board of Directors, November 16-17, 2009, and the item in question has to do with how a pilot national kidney exchange might be organized, if it overcomes some hurdles presently standing in its way. In particular, the cumbersome review process is catching up with the progress being made in regional kidney exchanges, in which chains have become important, expecially since the introduction of Non-simultaneous kidney exchange chains .

"The Committee supports the Kidney Transplantation Committee’s proposal to include living donors and donor chains in the Kidney Paired Donation Pilot Program. (Item 3, Page 6)."

Here it is:

"3. Proposal to include non-directed living donors and donor chains in the Kidney Paired Donation Pilot Program.

Currently, the Kidney Paired Donation (KPD) Pilot Program only allows living donors with incompatible potential recipients to participate. Non-directed (or altruistic) living donors (those who are not linked to an incompatible potential recipient) have no way to enter the program. Also, candidate / donor pairs can only be matched in groups of two or three, and all donor nephrectomies in the group must occur simultaneously. This proposal would allow non-directed living donors to participate in the KPD Pilot Program and add donor chains as an option in the system. A donor chain occurs when a non-directed living donor gives a kidney to a recipient whose living donor in turn gives a kidney to another recipient and continues the chain. This proposal would allow two types of donor chains: open and closed. Closed chains start with a non-directed living donor and end with a donation to a recipient on the deceased donor waiting list. Open chains start with a non-directed living donor and end with a bridge donor who will start another segment in the open chain. In open chains, the
bridge donor nephrectomy does not occur at the same time as the other living donor nephrectomies. Donor chains have the potential to increase the number of transplants in a KPD system.
The Committee used the scorecard to assess this policy, and the proposal received an overall score of 23.5. The proposal received average score of greater than 2.3 in every category except patient safety and oversight, geographical equity, and operational effectiveness.
The Committee unanimously supported this proposal by a vote of 9 in favor, 0 opposed, and 0 abstentions."