The OPTN Kidney Paired Donation Pilot Program (KPDPP): Reaching the Tipping Point in 2013.

Abstract

Background: U.S. living donor transplants (txs) reported as paired donations increased from 34 in 2004 to 527 in 2012. The OPTN KPDPP was launched in 2010 after KPD was determined not to violate the “valuable consideration” clause in NOTA. The program continues to make important policy and online system enhancements to increase transplant opportunities for patients with willing but incompatible living donors. This report highlights progress made by the OPTN KPDPP in participation, match offers, and txs. Methods: We analyzed tx candidate (TC) and living donor (LD) data submitted from Oct 2010 - Nov 2013 by tx centers participating in the OPTN KPDPP. 2-way, 3-way and chain exchanges were found using algorithms developed by Carnegie Mellon and Johns Hopkins Universities. Match success rates were defined as the percentage of matches (one TC and his matched donor) that were accepted and led to a transplant. Results: Through Nov 2013, 133 (58%) of 231 LD tx programs have agreed to participate with 92 (40%) having entered at least 1 pair. Over 900 TCs and LDs have been entered, with over 220 eligible pairs consistently participating in each weekly match run. In 2013, on average 82 matches were found each quarter with 5% of TCs finding a match in each run. Txs increased by 420% from 10 in 2012 to 52 in 2013, even as 64% of TCs entered were highly sensitized (HS), with CPRA≥80%. Txs included 23 HS TCs. Ethnic minorities comprised 34% of txs.Figure: No Caption available.The dramatic rise in transplants can be attributed to an increased number of matches being found coupled with a rise in the match success rate from 3% in 2012 to 10% in 2013. Conclusion: With the majority of the U.S. LD tx programs now participating, the OPTN KPDPP appears to have reached a tipping point in 2013, producing increasingly more txs, including for difficult-to-match and minority TCs. Though the match success rate has risen, the OPTN KPD Work Group continues to work on ways to increase the rate beyond the current 10%. The OPTN KPDPP is a robust, increasingly successful KPD program available to all LKD programs.