Controversies in Kidney Paired Donation

Sommer E. Gentry, Robert A. Montgomery, Dorry L. Segev

Research output: Contribution to journalReview articlepeer-review

Abstract

Kidney paired donation represented 10% of living kidney donation in the United States in 2011. National registries around the world and several separate registries in the United States arrange paired donations, although with significant variations in their practices. Concerns about ethical considerations, clinical advisability, and the quantitative effectiveness of these approaches in paired donation result in these variations. For instance, although donor travel can be burdensome and might discourage paired donation, it was nearly universal until convincing analysis showed that living donor kidneys can sustain many hours of cold ischemia time without adverse consequences. Opinions also differ about whether the last donor in a chain of paired donation transplants initiated by a nondirected donor should donate immediately to someone on the deceased donor wait-list (a domino or closed chain) or should be asked to wait some length of time and donate to start another sequence of paired donations later (an open chain); some argue that asking the donor to donate later may be coercive, and others focus on balancing the probability that the waiting donor withdraws versus the number of additional transplants if the chain can be continued. Other controversies in paired donation include simultaneous versus nonsimultaneous donor operations, whether to enroll compatible pairs, and interactions with desensitization protocols. Efforts to expand public awareness of and participation in paired donation are needed to generate more transplant opportunities.

Original languageEnglish (US)
Pages (from-to)257-261
Number of pages5
JournalAdvances in Chronic Kidney Disease
Volume19
Issue number4
DOIs
StatePublished - Jul 1 2012

Keywords

  • Altruistic donor
  • Desensitization
  • Incompatible
  • Kidney exchange
  • Kidney paired donation
  • Living donor
  • Nondirected donor

ASJC Scopus subject areas

  • Nephrology

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