MP79-12 HOW LONG IS TOO LONG? AN ANALYSIS OF THE IMPACT OF BRIDGE DONOR WAITING TIME ON PAIRED DONATION TRANSPLANTS

Abstract

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery I1 Apr 2015MP79-12 HOW LONG IS TOO LONG? AN ANALYSIS OF THE IMPACT OF BRIDGE DONOR WAITING TIME ON PAIRED DONATION TRANSPLANTS David Fumo, Timothy Suttle, Ryan Flynn, Laurie Reece, Stanislaw Stepkowski, Michael Rees, and Jonathan Kopke David FumoDavid Fumo More articles by this author , Timothy SuttleTimothy Suttle More articles by this author , Ryan FlynnRyan Flynn More articles by this author , Laurie ReeceLaurie Reece More articles by this author , Stanislaw StepkowskiStanislaw Stepkowski More articles by this author , Michael ReesMichael Rees More articles by this author , and Jonathan KopkeJonathan Kopke More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2869AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Non-simultaneous Extended Altruistic Donor (NEAD) chains and bridge donors (BD) are increasingly utilized in the field of Kidney Paired Donation (KPD), but remain controversial due to the possibility that such donors could renege on their promise to donate a kidney. The donor at the end of a NEAD chain is referred to as a BD, who is re-entered into the pool and trusted to donate after their incompatible recipient has received a transplant. This study evaluates how long bridge donors should wait. METHODS Data from a single United States KPD matching program was analyzed. To understand the impact of a BD subsequently failing to donate, a theoretical model was created in which a wait time limit (WTL) was placed on BDs. If the WTL was reached, the bridge donor was directed to the deceased donor waitlist and the chain was ended. If the WTL was not reached before a donor reneged, the chain ended with no additional transplant to the deceased donor waitlist. RESULTS A total of 90 BDs were used in 26 NEAD chains to complete 151 transplants. Nine BDs (10%) are currently suspended or withdrawn from the KPD pool. Though some of these donors may eventually donate, for the purpose of this study they were considered to have reneged. Of these 9 BD who appear to have reneged most were subsequently denied as donors for medical reasons; only 2 of 90 (2.2%) simply chose not to donate. No BD in a planned NEAD chain has failed to donate, so only BDs without initially identified potential recipients were included in the model (n=61). The maximum number of transplants was achieved with a WTL of 365 days (Figure 1), which would have resulted in 152 transplants/6 reneged BDs. By comparison, an unlimited WTL resulted in 148 transplants/9 reneges, while not allowing BDs to wait (WTL=0) would have achieved 89 transplants/0 reneges. The most significant gains in the number of transplants were seen with a WTL between 120 and 210 days (97 to 144 transplants). Four BDs reneged at 210 days, with an additional 2 reneging between 210 and 365 days. CONCLUSIONS This data suggests that a reasonable BD WTL should be at least 7 months, but not more than 1 year. To date, most BD reneging is actually medical disqualification, rather than a choice by the donor not to donate. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1015 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Fumo More articles by this author Timothy Suttle More articles by this author Ryan Flynn More articles by this author Laurie Reece More articles by this author Stanislaw Stepkowski More articles by this author Michael Rees More articles by this author Jonathan Kopke More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...