� 9/30/2016 Disclosures I have nothing to disclose Paired Exchange: Compatible Pairs and Process Valerie McBride, RN, BSN Kidney Transplant Exchange Coordinator Objectives Kidney Paired Donation Kidney Paired Donation Compatibility- Main Considerations � � � Compatibility � ABO: � Review � Pros/cons donor � Current status Recipient A B AB O Compatible Pairs � A X X � Definition B X X � Benefits AB X X X X � Limitations O X Additional Strategies � � Bridge donation � Advanced donation � 1
� 9/30/2016 Kidney Paired Donation Kidney Paired Donation Compatibility- Main Considerations Compatibility- � � � Crossmatch: Test with recipient and donors blood to � If the ABO and crossmatch are acceptable then it is make sure there are no preformed antibodies to the ok for transplant once both patients are approved donors tissue. � Want a negative result on testing. � Recipients may have formed antibodies with blood transfusion, pregnancy or previous transplant. Kidney Paired Donation Kidney Paired Donation Compatibility- Additional Considerations Goal to eliminate “incompatibility” in living donor � � transplant. � Tissue Match � HLA= Human Leukocyte Antigens Allows potential donors to donate on behalf of their � � Recipients HLA compared to donor HLA paired recipient versus directed only to. � Age Increases number of living donors able to � � Size participate. Removes recipients from an ever increasing � deceased donor wait list. � 2
� 9/30/2016 Kidney Paired Donation Kidney Paired Donation Loops Chains Pro’s Con’s � Allow more living � Many donor’s want to Non- kidney donation to Recipient donate directly Directed A Donor occur � Additional time and � Shorten the wait time higher cost for Donor Recipient A B of recipients transplant � Provide more � Shipping of organ if Recipient Donor B opportunity for hard matched nationally C B to match recipients � More difficult to End/ Donor schedule bridge C donor Kidney Paired Donation Compatible Pairs UCSF utilizes internal matching and the National Definition: � � Kidney Registry (NKR) � Donor’s who are ABO and Cross match compatible with designated recipient Numbers: � � Total exchanges � NKR-116 � Internal- 22 � Past 12 months � NKR-22 � Internal- 11 Current pool � � Recipient : 30 � blood type: A- 3, B- 1, AB-0, O- 26 � Donors: 31 � A-13, B-8, AB: 3, O- 7 � 3
� 9/30/2016 Compatible Pairs Compatible Pairs Benefit for patients: Potential for a better match Pair is able to designate time willing to wait for � � match. Surgery is scheduled for direct donation if � Age: look for a younger donor (grandparent no specified matches found donating) � Size: look for a larger size (small wife donating to Ideal patients are ABO: O donors with easy to � large husband) match A recipients � Tissue match: specify match desired (2 DR match) Compatible Pairs Compatible Pairs Benefit to the program Limitations � � � Provides a broader donor pool � Many pairs want to move as quickly as possible � Helps to alleviate the severe ABO: O shortage � Patients may not wish to incur additional risks of shipping the organ � Increases opportunity for highly sensitized patients � Family members may only wish to accept from known donor � 4
� 9/30/2016 Additional Stratagies Additional Stratagies Bridge Donation: Bridge Donation: � � � Donor at the end of the chain waits to donate instead � Allows for a greater number of transplants to be of going immediately to the wait list. scheduled. � Allows for donor to recover separately from recipient. Non- Recipient Directed This can be beneficial or difficult for the support A Donor based on patients individual situation � Donor is expected to donate independent of the Donor Recipient recipients outcome A B Recipient Donor B C B End/ Donor bridge C donor Additional Strategies Additional Strategies Advanced Donation Program (ADP) Advanced donation � � � Donor donates in advance of the recipient and begins � Good option for donors with time constraints or a new chain recipients not quite ready. � i.e. students, teachers, caregivers to be available for � Recipient receives transplant at the end of a chain support once donation has completed � Not appropriate for hard to match patients or ABO-O recipients at this time Non- Recipient Recipient ADP Directed A A Donor � Program changes currently to allow for donors to Donor provide credit for multiple family members with Recipien Recipien Donor Donor t t known kidney disease A A B B Recipient Recipient Donor B Donor B B C B C End/ Donor Donor ADP bridge Recipient C C donor � 5
� 9/30/2016 Kidney Paired Donation Questions? Patient safety is always most important concern. � Goal to minimize risk while increasing access to � living donation. Introduced early and often for a successful � program. Recipients may have more than one donor � evaluated throughout the process. � 6
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