The number of patients waiting for a kidney transplant continues to increase at an alarming pace and any significant gains in closing the gap between organ supply and demand are likely to come from the increased use of live donors, according to background information in the article. The two most significant barriers to greater use of live donors are blood type incompatibility and human leukocyte antigens (HLA) antigen sensitization. Based on blood group frequencies in the United States, there is a 36 percent probability that any two individuals will be blood type incompatible, eliminating up to one-third of the potential live donor pool. In about 30 percent of the patients on the deceased donor waiting list, HLA antigen sensitization is present due to exposure to foreign tissue in the form of previous transplants, pregnancies, or blood transfusions.
An alternative strategy is kidney paired donation (KPD) transplantations. In KPD transplants, incompatible donor/recipient pairs exchange kidneys so that each recipient receives a compatible organ. The KPD transplant program represents a cost savings compared with desensitization, which is significantly less costly than if an individual continues to undergo dialysis. While logistically challenging, a broader implementation of KPD on a regional or national scale could provide compatible organs for a substantial number of the estimated 6,000 patients on the waiting list who currently have incompatible donors.
Robert A. Montgomery, M.D., D.Phil., of Johns Hopkins University School of Medicine, Baltimore, and colleagues conducted a study to determine the feasibility and effectiveness of KP
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