Advice for setting up a kidney exchange program

 Advice from Italian doctors, on living kidney donation including kidney exchange, in the one year old journal Transplantology:

Living Kidney Donation: Practical Considerations on Setting Up a Program, by Maria Irene Bellini, Vito Cantisani 3, Augusto Lauro, and Vito D’Andrea, Transplantology 2021, 2(1), 75-86; https://doi.org/10.3390/transplantology2010008 

Abstract: Living kidney donation represents the best treatment for end stage renal disease patients, with the potentiality to pre-emptively address kidney failure and significantly expand the organ pool. Unfortunately, there is still limited knowledge about this underutilized resource. The present review aims to describe the general principles for the establishment, organization, and oversight of a successful living kidney transplantation program, highlighting recommendation for good practice and the work up of donor selection, in view of potential short- and long-terms risks, as well as the additional value of kidney paired exchange programs. The need for donor registries is also discussed, as well as the importance of lifelong follow up.

"The participation of a large number of transplant centers is vital to maximise the chances to achieve better human leucocyte antigen (HLA) or age match, thus it is envisaged that even compatible pairs for their recipients are involved, in order to generate more exchange opportunities. In view of the better outcomes, it is also recommended to include HLA incompatible (HLAi) pairs in preference to antibody removal, as well as ABO incompatible (ABOi) pairs to avoid the costs and higher risks associated with desensitization programs, or at least by registering them for a number of runs in the KPD before choosing these alternative treatments [7]. This applies specifically to children, where getting a well-matched kidney as early as possible is fundamental to preserve the long-term outcome, reducing the chances of sensitisation and being dialysis-dependent in the future to the minimum.

"Other effective ways to implement KPD are the inclusion of altruistic (unspecified) donors to trigger KPD chains; multiple registrations of potential donors for a single candidate; and the extension of the length of the exchanges, potentially also considering deceased donor kidneys as chain-initiating kidneys [8]."