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Kidney Exchange Innovative Kidney-Exchange Program Expands Options for Matching Recipients and Donors With more than 100,000 people on the waiting list nationwide, the demand for kidneys for transplantation far exceeds the supply of available donor organs. For some of these patients, it might be eight-to-10 years before a suitable deceased donor becomes available. Kidney exchange can change that equation. The UCLA Kidney Exchange Program is premised on the fact that many patients on the waiting list have a spouse, parent, sibling or other loved one who is motivated to donate but has an incompatible blood type or cross-match. One way the program expands the living-donor pool is through a kidney swap, in which two donor/recipient pairs who are incompatible trade donors so that each recipient obtains a compatible donor kidney. Another method involves donor chains, which create even broader opportunities to benefit more patients. The process typically begins when an altruistic individual offers to donate a kidney to a stranger who is on dialysis but has a willing-but-incompatible donor. After receiving the compatible kidney, the organ from the original patient’s incompatible donor is passed on to another patient on dialysis, and that patient’s willing-but-incompatible donor then does the same. This generous “paying it forward” builds the chain of transplants. To date, UCLA has performed approximately 170 chain kidney exchanges, more than any other center, and in 2015 performed 324 kidney transplants, more than any year in the program’s 50-year history, says Jeffrey Veale, MD, director of the UCLA Kidney Exchange Program. Most recently, a new innovation in the kidney-exchange program, called the Advance Donation Program, allows a donor to donate a kidney before his or her intended recipient needs one — either because the intended recipient’s kidney failure isn’t yet advanced enough to warrant a transplant or because the patient has a currently functioning kidney transplant but is expected to need a second transplant in the future, as renal allografts tend to last 10-to-20 years. The first-of-its-kind Advance Donation Program was launched in 2014 when a 64- year-old man approached the UCLA Kidney Exchange Program with the idea of donating his kidney to a stranger in exchange for a “coupon” that his young grandson, who had been diagnosed with kidney disease and was not yet on dialysis, could redeem years later when he needs a transplant. “There are a lot of people who could donate, but they want to wait until their loved one needs their kidney,” Dr. Veale says. “This gives them the opportunity to donate now with the promise that the loved one will get an organ if needed in the future. In the meantime, we can use that donated organ to start a chain.” Everyone wins from such actions, Dr. Veale notes. Patients who otherwise might have waited years for a kidney from a deceased donor receive a living-donor kidney, which, on average, lasts twice as long. This also shortens the waiting list for others. The recovery time associated with donation also is much lower than in the past, given the shift toward performing the donor nephrectomy laparoscopically. “There is a real humanity component to this program,” says Dr. Veale, who has received funding from the National Institutes of Health to study the characteristics of altruistic donors. “People are so grateful their loved one received a kidney from a stranger that they can’t wait to pass on the generosity to the next person to perpetuate the chain.” The story of one lifesaving transplant chain in which UCLA was instrumental is depicted in a 2013 online documentary, The Chain: thechain.org ABO blood type compatibility at a glance Can only receive from type O O A Can receive from type O or A B AB Can receive from type O or B Can receive from any blood type “There is a real humanity component to this program. People are so grateful their loved one received a kidney from a stranger that they can’t wait to pass on the generosity to the next person to perpetuate the chain.” 3 UCLA Physicians Update