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. 2021 Jan;21(1):103-113.
doi: 10.1111/ajt.16268. Epub 2020 Sep 19.

Deceased donors as nondirected donors in kidney paired donation

Wen Wang  1   2 , Michael A Rees  3 , Alan B Leichtman  2   4 , Peter X-K Song  1   2 , Mathieu Bray  5 , Valarie B Ashby  1   2 , Tempie Shearon  1   2 , Andrew Whiteman  1 , John D Kalbfleisch  1   2
Affiliations

Deceased donors as nondirected donors in kidney paired donation

Wen Wang et al. Am J Transplant. 2021 Jan.

Abstract

As proof of concept, we simulate a revised kidney allocation system that includes deceased donor (DD) kidneys as chain-initiating kidneys (DD-CIK) in a kidney paired donation pool (KPDP), and estimate potential increases in number of transplants. We consider chains of length 2 in which the DD-CIK gives to a candidate in the KPDP, and that candidate's incompatible donor donates to theDD waitlist. In simulations, we vary initial pool size, arrival rates of candidate/donor pairs and (living) nondirected donors (NDDs), and delay time from entry to the KPDP until a candidate is eligible to receive a DD-CIK. Using data on candidate/donor pairs and NDDs from the Alliance for Paired Kidney Donation, and the actual DDs from the Scientific Registry of Transplant Recipients (SRTR) data, simulations extend over 2 years. With an initial pool of 400, respective candidate and NDD arrival rates of 2 per day and 3 per month, and delay times for access to DD-CIK of 6 months or less, including DD-CIKs increases the number of transplants by at least 447 over 2 years, and greatly reduces waiting times of KPDP candidates. Potential effects on waitlist candidates are discussed as are policy and ethical issues.

Keywords: donors and donation: deceased; donors and donation: paired exchange; health services and outcomes research; kidney transplantation/ nephrology; simulation; statistics.

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Conflict of interest statement

Disclosure

The authors of this manuscript have conflicts of interest to disclose as described by the American Journal of Transplantation. Dr. Michael Rees has an ownership interest in Rejuvenate Healthcare, LLC, and is the non-compensated CEO of the Alliance for Paired Kidney Donation. Dr. Mathieu Bray contributed to this project while he was a PhD student at the University of Michigan. He is now employed as a statistical scientist at GlaxoSmithKline, SLC.

Figures

Figure 1:
Figure 1:
Distribution of CPRA in the KPDP over time is presented for KPD&DD and KPD-only strategies. Candidates whose CPRA is ≥ 98% are excluded from this figure. (On average there are about 119 candidates with CPRA ≥98% in the initial mature pool.) Results are for an initial pool size of 400 and an untransplanted departure rate of 0.0005 per day. In 1a, results are averaged across simulations including NDD arrival rates of 12, 36 or 60 per year and delay times of 0, 3 or 6 months. In 1b, results are averaged across all simulations including pair arrival rates of 365 or 730 per year and NDD arrival rates of 12, 36 or 60 per year.
Figure 2:
Figure 2:
Distribution of Blood Type in the KPDP over time is presented for KPD&DD and KPD only strategies. Candidates whose CPRA is larger than 97 are excluded from this figure. (On average there are about 119 candidates with CPRA ≥98% in the initial mature pool.) Results are for an initial pool size of 400 and an untransplanted pair departure rate of 0.0005 per day. In 2a, results are averaged across simulations including NDD arrival rates of 12, 36 or 60 per year and delay times of 0, 3 or 6 months. In 2b, results are averaged across all simulations including pair arrival rates of 365 or 730 per year and NDD arrival rates of 12, 26 or 60 per year.
Figure 3:
Figure 3:
Average cumulative numbers of transplants to KPDP candidates by LDs, DDs, chains and cycles over time for KPD&DD and KPD only strategies with an initial pool size of 400 and untransplanted pair departure rate of 0.0005 per day. In 3a, results are averaged across simulations including 365 or 730 pair arrivals per year and delay times of 0, 1, 3, 6 or 12 months. In 3b, results are averaged across all simulations including 36 or 60 NDDs per year and delay times of 0, 1, 3, 6 or 12 months.
Figure 4:
Figure 4:
Average Kaplan-Meier estimates for KPDP candidate wait times categorized by CPRA (Figure 4a) and candidate blood type (Figure 4b) for KPD&DD and KPD-only strategies. Results are for an initial pool size of 400, an untransplanted departure rate of 0.0005 per day, pair arrival rate of 365 per year and a delay time of 3 months. Results are averaged over NDD arrival rates of 12, 36, 60 per year.
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References

    1. Park K, Moon JI, Kim SI, et al. Exchange Donor Program in Kidney Transplantation. Transplantation 1999;67(2):336–338. - PubMed
    1. Rapaport FT. The case for a living emotionally related international kidney donor exchange registry. In: Transplantation Proceedings; 1986. p. 5. - PubMed
    1. Gentry SE, Montgomery RA, Segev DL. Kidney Paired Donation: Fundamentals, Limitations, and Expansions. American Journal of Kidney Diseases 2011;57(1):144–151. - PubMed
    1. Wallis CB, Samy KP, Roth AE, et al. Kidney paired donation. Nephrology Dialysis Transplantation 2011;26(7):2091–2099. - PubMed
    1. Roth AE, Sönmez T, Utku Ünver M. Pairwise kidney exchange. Journal of Economic Theory 2005;125(2):151–188.

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