Saturday, April 18, 2015

Kidney exchange in Switzerland

Here's a paper reviewing kidney exchange around the world, from an Australian perspective (Paolo Ferrari has been one of the Australian pioneers), and advocating for a national kidney exchange program in Switzerland...

Kidney paired donation: a plea for a Swiss National Programme

Karine Hadayaa,b, Thomas Fehrc, Barbara RĂ¼sic, Sylvie Ferrari-Lacrazd, Jean Villardd, Paolo Ferrarie,f
a Service of Nephrology. Geneva University Hospital, Geneva, Switzerland
b Service of Transplantation, Geneva University Hospital, Geneva, Switzerland
c Service of Nephrology and Histocompatibility laboratory, Zurich University Hospital, Switzerland
d Transplant Immunology Unit and National Reference Laboratory for Histocompatibility (LNRH), Division of Immunology, Allergy and Laboratory Medicine, Geneva, Switzerland
e Department of Nephrology, Prince of Wales Hospital and Clincal School, University of New South Wales, Randwick, Sydney, Australia
f Organ and Tissue Authority, Australia

Summary

Growing incidence of end-stage renal disease, shortage of kidneys from deceased donors and a better outcome for recipients of kidneys from living donor have led many centres worldwide to favour living donor kidney transplantation programmes. Although criteria for living donation have greatly evolved in recent years with acceptance of related and unrelated donors, an immunological incompatibility, either due to ABO incompatibility and/or to positive cross-match, between a living donor and the intended recipient, could impede up to 40% of such procedures. To avoid refusal of willing and healthy living donors, a number of strategies have emerged to overcome immunological incompatibilities. Kidney paired donation is the safest way for such patients to undergo kidney transplantation. Implemented with success in many countries either as national or multiple regional independent programmes, it could include simple exchanges between any number of incompatible pairs, incorporate compatible pairs and non-directed donors (NDDs) to start a chain of compatible transplantations, lead to acceptance of ABO-incompatible matching, and integrate desensitising protocols. Incorporating all variations of kidney paired donation, the Australian programme has been able to facilitate kidney transplantation in 49% of registered incompatible pairs. This review is a plea for implementing a national kidney paired donation programme in Switzerland.
Swiss Med Wkly. 2015;145:w14083

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