A new strategy to allocate kidneys from living donors could increase the number of patients that benefit from transplantation, according to a paper in this week's issue of The Lancet.

Living non-directed (LND) donors are individuals who are willing to donate an organ when alive without there being a designated recipient. Since the first LND donation in 1998, there have been 302 procedures recorded in the USA to date. At present there is no universally accepted system for donation of organs from LND donors. Sometimes patients may find a willing live donor but direct donation may not be possible if their blood type does not match. Donor-receipt pairs can enter programmes to facilitate donation between pairs but usually more than 50% of the incompatible pairs in the pool remain unmatched.

Robert Montgomery (Johns Hopkins University School of Medicine, Baltimore, MD, USA) and colleagues examined a new strategy called domino paired donation, where the LND donor's kidney is matched to a recipient who has a willing but incompatible donor. The recipient's incompatible donor can, in turn, agree to give a kidney to the next compatible patient on the waiting list, producing a domino effect. The researchers estimated that if domino paired donation had been adopted in the USA since the first LND donation, 583 transplants would have been accomplished, rather than 302.

Dr Montgomery states: "At a time of growing crisis in organ availability, this study shows that the current system of allocating LND donor organs does not achieve the greatest possible benefit from this new and growing source of kidneys. Implementation of domino paired donation on a national or regional scale should improve consistency and fairness across transplant centresOur study shows that the use of domino paired donation has the potential to increase both the quantitative and qualitative benefit of each LND donation"

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Contact: Joe Santangelo
j.santangelo@elsevier.com
212-633-3810
Lancet
27-Jul-2006