Wednesday, October 18, 2017

Chronologically incompatible patient-donor pairs: more on vouchers for future transplants

 Here's the published version of a paper I've blogged about before, followed by a comment, in the September issue of the journal Transplantation.

Vouchers for Future Kidney Transplants to Overcome “Chronological Incompatibility” Between Living Donors and Recipients
Veale, Jeffrey L.; Capron, Alexander M.' Nassiri, Nima; Danovitch, Gabriel; Gritsch, H. Albin; Waterman, Amy; Del Pizzo, Joseph; Hu, Jim C.; Pycia, Marek; McGuire, Suzanne; Charlton, Marian; Kapur, Sandip
Transplantation: September 2017 - Volume 101 - Issue 9 - p 2115–2119

"The donation of a kidney at a time that is optimal for the donor generates a “voucher” that only a specified recipient may redeem later when needed. The voucher provides the recipient with priority in being matched with a living donor from the end of a future transplantation chain."

Paying It Forward: Live Kidney Donation Now to (POSSIBLY) Benefit a Long-term Future Recipient
Sellers, Marty T. , Transplantation: September 2017 - Volume 101 - Issue 9 - p 1965–1966

"As intriguing as this extension of the National Kidney Registry’s Advanced Donation Program is, thoughtful questions emerge. It is unclear how 2 or more voucher holders would be prioritized with respect to one another as chain-ending recipients if each could end a future chain. The authors offer 2 possible factors to consider (highest panel reactive antibody, length of time holding a voucher), and both are arguably not individually or collectively sufficient. Should the number of transplants facilitated by the original donation(s) also be considered? This could (perhaps unfairly) advantage the recipient who held multiple vouchers—for example, the voucher holder in cases 2 and 3 in the article—and would incentivize more donors. Should HLA matching be an overriding factor? Should life-years from transplant matter? Time on dialysis? How about length of the future chain? The authors do note the current framework might not address all future situations; if the program becomes widely adopted, these potential situations become more likely and deserve proper forethought. "

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