Novel Approaches to Expanding Benefits from Living Kidney Donor Chains

Abstract

Although allocation strategies such as kidney paired donation (KPD) have helped to enhance transplant opportunities for immunologically incompatible recipient and donor pairs, further expansion and optimization of KPD is possible. This review examines Global Kidney Exchange and Deceased Donors as Chain-Initiating Kidneys, two novel strategies aimed to expand the benefits of KPD. Global Kidney Exchange offers the opportunity to utilize the mechanism of kidney exchange to overcome financial barriers to kidney transplantation, thus increasing the pool of participating pairs, unlocking more chains, avoiding costs from dialysis, and expanding kidney transplantation to serve impoverished patients. The Deceased Donors as Chain-Initiating Kidneys strategy aims to increase matching opportunities by using deceased donor kidneys to initiate KPD chains. We find that both ideas offer the promise of more kidney transplants and a reduction in the personal and economic burden caused by ESRD.