Kidney transplant chains amplify benefit of nondirected donors Journal Article


Authors: Melcher, M. L.; Veale, J. L.; Javaid, B.; Leeser, D. B.; Davis, C. L.; Hil, G.; Milner, J. E.
Article Title: Kidney transplant chains amplify benefit of nondirected donors
Abstract: IMPORTANCE: Despite the potential for altruistic nondirected donors (NDDs) to trigger multiple transplants through nonsimultaneous transplant chains, concerns exist that these chains siphon NDDs from the deceased donor wait list and that donors within chains might not donate after their partner receives a transplant. OBJECTIVE: To determine the number of transplantations NDDs trigger through chains. DESIGN: Retrospective review of large, multicenter living donor-recipient database. SETTING: Fifty-seven US transplant centers contributing donor-recipient pairs to the database. PARTICIPANTS: The NDDs initiating chain transplantation. MAIN OUTCOMES MEASURE: Number of transplants per NDD. RESULTS: Seventy-seven NDDs enabled 373 transplantations during 46 months starting February 2008. Mean chain length initiated by NDDs was 4.8 transplants (median, 3; range, 1-30). The 40 blood type O NDDs triggered a mean chain length of 6.0 (median, 4; range, 2-30). During the interval, 66 of 77 chains were closed to the wait list, 4 of 77 were ongoing, and 7 of 77 were broken because bridge donors became unavailable. No chains were broken in the last 15 months, and every recipient whose incompatible donor donated received a kidney. One hundred thirty-three blood type O recipients were transplanted. CONCLUSION AND RELEVANCE: This large series demonstrates that NDDs trigger almost 5 transplants on average, more if the NDD is blood type O. There were more blood type O recipients than blood type O NDDs participating. The benefits of transplanting 373 patients and enabling others without living donors to advance outweigh the risk of broken chains that is decreasing with experience. Even 66 patients on the wait list without living donors underwent transplantation with living-donor grafts at the end of these chains.
Keywords: Adult; Aged; Female; Humans; Middle Aged; Young Adult; Male; Retrospective Studies; Algorithms; United States; Urology; Kidney Transplantation; Waiting Lists; Donor Selection/methods; Living Donors/supply distribution; Tissue Donors/supply distribution; Tissue and Organ Procurement/organization administration
Journal Title: JAMA surgery
Volume: 148
Issue: 2
ISSN: 2168-6262; 2168-6254
Publisher: Unknown  
Journal Place: United States
Date Published: 2013
Start Page: 165
End Page: 169
Language: eng
DOI/URL:
Notes: LR: 20130715; JID: 101589553; CIN: Nat Rev Nephrol. 2013 Apr;9(4):188. PMID: 23478413; ppublish
LUC Authors
  1. John Milner
    8 Milner
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