Kidney paired donation (KPD), or paired exchange, is an approach to living donor kidney transplantation where patients with incompatible donors swap kidneys to receive a compatible kidney. KPD is used in situations where a potential donor is incompatible. Because better donor HLA and age matching are correlated with lower lifetime mortality[1] and longer lasting kidney transplants,[2] many compatible pairs are also participating in swaps to find better matched kidneys. In the United States, the National Kidney Registry organizes the majority of U.S. KPD transplants,[3][4][5] including the largest swaps. The first large swap was a 60 participant chain in 2012 that appeared on the front page of the New York Times[6] and the second, even larger swap, included 70 participants and was completed in 2014.[7] Other KPD programs in the U.S. include the UNOS program, which was launched in 2010 and completed its 100th KPD transplant in 2014,[8][9] and the Alliance for Paired Donation.[10]
According to a 2019 study, kidney exchanges improve overall transplant quality, which leads to fewer transplant failures. The exchanges also reduce waiting times for patients needing kidney transplants. The study found that the health care cost savings of kidney exchanges are substantial.[11]
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