Paired Kidney Exchange: A Major Breakthrough in Kidney Transplantation

The potential of Paired Kidney Exchange transplantation is what we’re talking about. The most difficult aspect of becoming a transplantation surgeon is determining the bounds of perhaps the world’s most essential resource – lifesaving organs for those in need. Every day, individuals die on the waiting list as their chance never arrives, and the number of people added to that list rises dramatically.

We shall never allow ourselves to believe that there is no room for improvement in transplantation. It’s impossible to be comfortable with the status quo, and we must constantly strive for the next breakthrough, discovery, or chance. The Division of Transplantation at the University of Maryland is proud to be the destination where people come for answers when others can’t provide them.

Paired Kidney Exchange Programme

The University of Maryland has long been a leader in surgical innovation and patient access to organ transplantation. Another choice we provide is paired kidney exchange (PKE). The Acute Care Transplant Program is a program for patients who have a healthy living donor, but who are incompatible with their intended recipient. In the past, we were compelled to inform both the donor and the recipient that they had no choice but to wait an average of three to five years for a deceased donor transplant, knowing many people would never see that day.

As we discovered more pairs were unsuitable, we knew that another opportunity was required. We’ve changed “no” into “yes” with paired kidney exchange, and we’re excited about the possibilities.

In the last few months, the University of Maryland completed four-way kidney exchanges involving eight individuals from four states, a two-way kidney exchange with a hospital in Minnesota, and the third exchange between a patient at Johns Hopkins University Hospital and one in New York.

The paired exchange program is not available to all institutions, in part because of the complexity of the organization required to execute these procedures either internally or with other medical facilities.  For example, a kidney transplant will require the donor and recipient to travel to different areas of the country or across borders. To minimize time spent waiting for an organ to be transplanted, organs are often flown from one region of the United States to another — this may involve flying an organ from Los Angeles to New York City or Toronto. There must also be a commitment on the part of the healthcare system to provide ample space for these many transplants, as well as unusual operation schedules. We set ambitious goals for this transplant program, remove roadblocks for patients, and open the door to many people to get the Gift of Life.

The introduction of this new initiative has injected a tremendous amount of vitality into the transplant field. We’re seeing people who have been searching for a match for years, and it’s because of blood type incompatibility or high levels of antibodies to their donor. We’re seeing their intended contributors (the most of them close family members) ecstatic about the prospect of not just seeing their loved one off dialysis, but also assisting another person. The trickle-down effect is something to marvel at. Patients are now presenting potential donors for the PKE program, which they had never considered because of their prior understanding of blood type incompatibility. Everyone is now an ‘opportunity’ for one another.

We take the practice of living donations extremely seriously. We are first and foremost governed by the ideal of “Do No Harm.” The University of Maryland has the most rigorous criteria for assessing and ensuring the safety of living donation in the country. The University of Maryland recognizes the importance of the donor’s trust, as well as that of the beneficiary and their family in trusting us to take care of their Hero who is giving them this gift.

We believe that our standards for donors in the PKE program should be higher, as they have most often never met the recipient of their donated kidney. While we preserve the privacy of all involved, we demand informed consent from all donors and recipients, as well as answer any queries until it is certain and understandable.

We’ll keep looking for new and improved solutions for people facing the prospect of end-stage renal disease. We can no longer use incompatibility with a living donor as an excuse to deny kidney disease patients the Gift of Life. Paired kidney exchanges will become the norm of care at major transplant centers and will be a routine procedure at the University of Maryland, where we are dedicated to pushing the state of the art in kidney transplantation for our patients.

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