Disclosures I have nothing to disclose Paired Exchange: Compatible - - PowerPoint PPT Presentation

9/30/2016 1

Paired Exchange: Compatible Pairs and Process

Valerie McBride, RN, BSN Kidney Transplant Exchange Coordinator

Disclosures

I have nothing to disclose

Objectives

• Kidney Paired Donation

Compatibility Review Pros/cons Current status

• Compatible Pairs

Definition Benefits Limitations

• Additional Strategies

Bridge donation Advanced donation

Kidney Paired Donation

• Compatibility- Main Considerations

ABO:

donor Recipient

A B AB O A X X B X X AB X X X X O X

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Kidney Paired Donation

• Compatibility- Main Considerations

Crossmatch: Test with recipient and donors blood to

make sure there are no preformed antibodies to the donors tissue.

Want a negative result on testing. Recipients may have formed antibodies with blood

transfusion, pregnancy or previous transplant.

Kidney Paired Donation

• Compatibility-

If the ABO and crossmatch are acceptable then it is

• k for transplant once both patients are approved

Kidney Paired Donation

• Compatibility- Additional Considerations

Tissue Match

HLA= Human Leukocyte Antigens Recipients HLA compared to donor HLA

Age Size

Kidney Paired Donation

• Goal to eliminate “incompatibility” in living donor

transplant.

• Allows potential donors to donate on behalf of their

paired recipient versus directed only to.

• Increases number of living donors able to

participate.

• Removes recipients from an ever increasing

deceased donor wait list.

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Kidney Paired Donation

Loops Chains

End/ bridge donor Donor C Recipient A Donor B B Donor A Non- Directed Donor Recipient B Recipient C

Kidney Paired Donation

Pro’s

Allow more living

kidney donation to

• ccur

Shorten the wait time

• f recipients

Provide more

• pportunity for hard

to match recipients Con’s

Many donor’s want to

donate directly

Additional time and

higher cost for transplant

Shipping of organ if

matched nationally

More difficult to

schedule

Kidney Paired Donation

• UCSF utilizes internal matching and the National

Kidney Registry (NKR)

• 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

Compatible Pairs

• Definition:

Donor’s who are ABO and Cross match compatible

with designated recipient

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Compatible Pairs

• Benefit for patients: Potential for a better match

Age: look for a younger donor (grandparent

donating)

Size: look for a larger size (small wife donating to

large husband)

Tissue match: specify match desired (2 DR match)

Compatible Pairs

• Pair is able to designate time willing to wait for
• match. Surgery is scheduled for direct donation if

no specified matches found

• Ideal patients are ABO: O donors with easy to

match A recipients

Compatible Pairs

• Benefit to the program

Provides a broader donor pool Helps to alleviate the severe ABO: O shortage Increases opportunity for highly sensitized patients

Compatible Pairs

• Limitations

Many pairs want to move as quickly as possible Patients may not wish to incur additional risks of

shipping the organ

Family members may only wish to accept from known

donor

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Additional Stratagies

• Bridge Donation:

Donor at the end of the chain waits to donate instead

• f going immediately to the wait list.

End/ bridge donor Donor C Recipient A Donor B B Donor A Non- Directed Donor Recipient B Recipient C

Additional Stratagies

• Bridge Donation:

Allows for a greater number of transplants to be

scheduled.

Allows for donor to recover separately from recipient.

This can be beneficial or difficult for the support based on patients individual situation

Donor is expected to donate independent of the

recipients outcome

Additional Strategies

• Advanced Donation Program (ADP)

Donor donates in advance of the recipient and begins

a new chain

Recipient receives transplant at the end of a chain

• nce donation has completed

End/ bridge donor Donor C Recipient A Donor B B Donor A ADP Donor Recipien t B Recipient C ADP Recipient Donor C Recipient A Donor B B Donor A Non- Directed Donor Recipien t B Recipient C

Additional Strategies

• Advanced donation

Good option for donors with time constraints or

recipients not quite ready.

i.e. students, teachers, caregivers to be available for

support

Not appropriate for hard to match patients or ABO-O

recipients at this time

Program changes currently to allow for donors to

provide credit for multiple family members with known kidney disease

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Kidney Paired Donation

• 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.

Questions?