Kidney paired donation programs for incompatible living kidney donors and recipients

Living kidney donors who are not compatible with their intended recipients are increasingly joining programs designed to match them to exchange opportunities with other donors and recipients. By circumventing or attenuating the incompatibility, kidney paired donation (KPD), or kidney exchange, allows more living donors to facilitate their recipients’ transplants. A higher proportion of incompatible pairs can find matches in programs that enroll more pairs, and in programs that incorporate compatible pairs and/or nondirected donors and combine paired exchange with desensitization. Several registries provide matching services for incompatible pairs in the US, including one program administered by the United Network for Organ Sharing. Making the most of KPD has required advances in live donor organ transport, mathematics for optimized matching, and logistical and financial coordination.