1. Paired and AltruisticPaired and Altruistic
Kidney Donation InKidney Donation In
The UKThe UK
Deborah Green
North Bristol Academy

2. ObjectivesObjectives
 Why this topic?
 Paired donation
 The process
 UK programme and problems
 Altruistic donation
 Definition and development
 Programmes worldwide
 Patient views

3. Kidney DonationKidney Donation
 Types: DECEASED
LIVE
 Problems
1. ABO incompatibility
2. Presence of donor-specific
HLA antibodies

4. Paired DonationPaired Donation
Scheme run by BTS and UKT since 2007
DONOR 1 RECIPIENT 1
DONOR 2 RECIPIENT 2

5. The Matching ProcessThe Matching Process
Quarterly matching runs
Three stages:
Identify all possible two-way exchanges
Determine all combinations of exchange
Identify optimum combinations

6. Identifying Optimum Transplant NumberIdentifying Optimum Transplant Number
Criteria Points
Location of pairs •Same area - 20
•Otherwise - 0
HLA Match •Level 1 – 15
•Level 4 – 0
Sensitisation •0 – 50 points
Donor – donor age
difference
•< 20 years – 3 points
•> 20 years – 0 points
Blood group matching •O donors reserved for O
recipients

7. UK Programme Jan 2007 – Jan 2011UK Programme Jan 2007 – Jan 2011
465 patients enrolled
198 transplants identified
51% of identified transplants have not
taken place

8. Outcome of Identified TransplantsOutcome of Identified Transplants
0
5
10
15
20
25
30
35
40
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Not proceeding
Transplant
No. of
potential
transplants
Matching runApr 2007 Jan 2011
(Data from UKT)

9. Non-Proceeding TransplantsNon-Proceeding Transplants
Pos XM
38%
Alternative
transplant
20%
Donor or recipient
unfit
24%
Other
18%
(Data from UKT)

10. ExplanationsExplanations
Large proportion of highly sensitised
patients in UK cohort
◦ 97% UK
◦ 41% The Netherlands
(Johnson et al 2008)
Blood type skewing
◦ 50% of pairs with blood type O recipients
◦ 30% of pairs with blood type O donors
(15% match rate for O recipients currently)
(Johnson et al 2008)

11. SolutionsSolutions
1.Allowing compatible pairs to join the
paired scheme
• Simulation studies show up to 75%
increase in match rate for O recipients
(Gentry et al. 2007)
2.Combining desensitisation with paired
donation
• Complimentary modalities in the US for
difficult to match patients. (Segev et al. 2008)

12. Altruistic DonationAltruistic Donation
Individual live donors with no genetic or
personal link to a recipient.
60 altruistic donations in the UK to date

13. Altruistic DonationAltruistic Donation
0
200
400
600
800
1000
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Altruistic donor (non-directed)
Paired exchange donor
ABO incompatible donor
HLA incompatible donor
Unrelated donor (directed)
Related donor
(Data from UKT)
Tx N◦
Year

14. Where Do They Fit in?Where Do They Fit in?
Donate to a recipient high on the
deceased waiting list
Donate to the paired donor scheme
◦ Transplant numbers increased 1.6 times per
altruistic donor
(Roodnat et al 2010)

15. Domino-Paired DonationDomino-Paired Donation
• Two transplants take place

16. ReflectionReflection
 Potential for the paired scheme to help many
unmatched patients
 Making best use of altruistic donors
 MDT involvement at many levels
 Impact on lives of patients

17. What the patients say...What the patients say...
‘...I was on dialysis for 5 years
before they finally found a
match. I just wanted to die in my
sleep...’
‘ You feel so helpless. He was so ill
and I wasnt able to do anything but
wait...’
Any Questions?

18. ReferencesReferences
 Gentry SE, Montgomery RA, Segev DL. Kidney Paired Donation: Fundamentals, Limitations and Expansions.
American Journal of Kidney Diseases. 2011; 57(1): 144-151
 Johnson RJ, Allen JE, Fuggle SV, Bradley JA, Rudge C. Early Experience of Paired Living Kidney Donation In The
UK. Transplantation. 2008; 86(12): 1672-1677
 Mongomery RA, Renal Transplantation Across HLA and ABO Antibody Barriers: Integrated Paired Donation
Into Desensitisation Protocols. American Journal of Transplantation. 2010; 10: 449-457
 Rapaport FT. The case for a living emotionally related international kidney donor exchange registry.
Transplant Proc. 1986; 18: 5
 Kwak JY, Kwon OJ, Lee KS et al. Exchange-donor program in renal transplantation: A single centre experience.
Transplant Proc. 1999; 31: 344
 Johnson RJ et al. Paired and Altruistic Non-Directed Living Kidney Donation. Renal Transplant Services Meeting
January 2011. Accessed March 2011
 Segev DL, Kucirka LM, Gentry SF, Montgomery RA. Utilisation And Outcomes Of Kidney Paired Donation In
the US. Transplantation. 2008; 86: 502-510
 Gentry SE, Segev DL, Simmerling M, Mongomery RA. Expanding Kidney Paired Donation Through Participation
By Compatible Pairs. American Journal of Transplantation. 2007; 7: 2361-2370
 Gentry SE, Montgomery RA, Swihart BJ, Segev DL. The roles of dominos and never-ending altruistic donor
chains in kidney paired donation. American Journal of Transplantation. 2009; 9: 1330-1336
 The National Matching Scheme For Paired Donation. Available at www.bts.org.uk. Accessed March 2011
 UK Transplant. Available at www.uktransplant.org.uk. Accessed February 2011