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Kidney
Exchange Kidney-Transplant Chains Help to
Keep Patients and Hope Alive
Demand for donor kidneys is far greater than
the supply, and some patients must wait as long
as a decade for a suitable donor. While a loved
one or friend may be motivated to donate, about
one-third of the time they are unable to do so
because they are not immunologically compatible.
But an innovative program that exchanges the
kidney from an incompatible family or friend
for a compatible kidney from a stranger is giving
UCLA patients hope of being freed from the
constraints of dialysis. “It’s a winning situation
for everyone,” says Jeffrey Veale, MD, assistant
professor of urology and director of the UCLA
Kidney Exchange Program. “Instead of waiting
years for a deceased-donor kidney, patients can
quickly receive a living-donor kidney — which
in general lasts twice as long. Additionally,
once these patients receive their living-donor
kidney they are removed from the deceased-
donor waiting list, reducing the competition for
cadaveric organs.”
STORY HIGHLIGHTS
A transplant chain begins when an
altruistic donor gives his or her kidney
to a recipient who already has a
willing donor but that donor’s organ
is incompatible.
UCLA has one of the world’s highest-
volume kidney-transplantation programs
and is the most active chain-transplantation
center in the United States.
reciprocal blood types. Each child wanted to
donate a kidney to his or her individual parent but
had an incompatible blood type with their own
parent. Dr. Veale simply swapped the kidneys
by having each child donate to the other
child’s parent.
UCLA has one of the world’s highest-volume
kidney-transplantation programs and is the most
active chain-transplantation center in the United
States, performing 90 chain transplantations
to date. “Besides getting people transplanted
rapidly with the highest-quality organs, there’s a
real humanity component to this program,” says
Dr. Veale. “It’s beautiful to see people giving and
receiving kidneys from complete strangers. The
recipient usually doesn’t meet the donor until
after the transplantation, and I feel extremely
fortunate to often be the one who gets to make
that initial introduction.”
“However, none of this would be possible without
the generosity of altruistic donors to trigger the
chains,” says Dr. Veale. “There are no obvious
benefits for altruistic donors, and they are
putting themselves at risk for a total stranger. I
don’t think our society has adequately recognized
the heroism of altruistic donors.”
A transplant chain begins when an altruistic
donor gives his or her kidney to a recipient who
already has a willing donor but that donor’s
organ is incompatible. That recipient’s willing but
incompatible donor then passes on the generosity
to a different recipient, whose willing but
incompatible donor does the same, keeping the
chain alive. A specialized computer program run
by the National Kidney Registry matches donors
and recipients across the country.
The UCLA Exchange Program began in 2007
and at first used a simpler exchange formula. At
that time, there were two parent/child pairs with
UCLAHEALTH.ORG 1-800-UCLA-888 (1-800-825-2888)
Dr. Veale was senior author on a recent article that
reported the results of 272 chain transplantations
(the largest study to date). Approximately
50 percent of the chain recipients were female
and 46 percent were ethnic minorities — two
groups that have historically had a difficult
time finding matches due to their naturally
elevated antibody levels.
Dr. Veale is in the process of reporting UCLA’s
experience in transplanting living-donor kidneys
that have been shipped from the East Coast after
being on ice for 10-to-18 hours. “As transplant
chains have gained popularity, a donor that could
unlock a recipient at our center often lives on the
East Coast. Rather than having the donor fly to
Los Angeles, the kidney is shipped. Initially there
was concern that placing living-donor kidneys
on ice for prolonged periods of time would affect
their function. However, this doesn’t seem to be
the case. In fact, the living-donor kidneys appear
to function just as well if they are removed in
the operating room next door or in New York,”
Dr. Veale says.