The Paired Exchange Conundrum

Imagine the frustration of having a kidney donor who is willing and healthy enough to donate but they are not compatible with you. This happens to approximately 30% of potential donors.
As a result of medical technology, better anti-rejection drugs and paired exchanges, (also called swaps or chains), these incompatible donors are able to help their intended recipient by donating to another recipient who also has an incompatible donor. In short, these two recipients swap their incompatible donors. (I’ve used two pairs for this example, there could be many pairs in a paired exchange.) Paired exchanges have the potential of increasing the number of kidney transplants by thousands a year if a centralized national program is developed that will register ALL incompatible pairs. The likelihood of being matched with another incompatible pair is increased when there are many incompatible pairs within your pool or when you register with many different paired exchange programs.
The Conundrum

Unlike the waiting list for a deceased donor kidney, there isn’t one national paired exchange program that lists all incompatible pairs. Here are the different types of paired exchange programs that have been developed:

1. If your transplant hospital has a paired exchange program then they will try to match you with the other incompatible pairs that are registered at their hospital.
2. Some hospitals share some or all of their incompatible pairs with other local hospitals or ones in different parts of the U.S.
3. Hospitals, i.e. Mayo Clinic has many transplant centers in different markets and they share their information within those hospitals.
4. There are three national organizations that don’t do transplants but they have developed a “co-op” type relationship with many transplant centers. These hospitals list their incompatible pairs with the “co-op.” To get registered with a “co-op” organization(s) you need to register with one of their affiliates. Keep in mind, that an affiliate hospital is not required to share ALL of their incompatible pairs with this “co-op” organization. If you register with an affiliated center you must confirm with that center that they have registered you with your intended “co-op.”
5. You can register with multiple centers for a paired exchange and with multiple “co-op” organizations. With private health insurance, you need to check to makes sure you are covered at other hospitals. Those with Medicare are covered at all transplant hospitals.

Here’s a list of the three “co-op” organizations: (National Kidney Registry is doing more paired exchanges than the other two groups.)

Alliance for Paired Donation - www.paireddonation.org
Alliance affiliated centers - www.paireddonation.org/transplant-center/
National Kidney Registry - www.kidneyregistry.org
NKR affiliated centers – www.kidneytransplantcenters.org/center/index
UNOS - www.transplantpro.org
UNOS affiliated centers - https://optn.transplant.hrsa.gov/media/3019/optnkpdppcentersbystate.pdf

You should ask if your hospital is involved with other paired exchange programs and whether they share ALL of their incompatible pairs. Some hospitals will keep the pairs that are easy to match and offer the more difficult pairs to their exchange member(s). This is not an efficient way of maximizing paired exchange programs.

The three national “co-op” organizations, evaluate pairs anonymously. When a transplant center is matching you with other incompatible pairs within their center the committee(s) that evaluates paired exchange candidates could be the same doctors that care for these patients. Knowing the identity of the patients could work in your favor or against you.

Here’s what you could do to maximize your chances of being matched with another incompatible pair:

1. Register with your original transplant hospital’s paired exchange program.
2. Find hospitals that participate with one or more of the three national “co-op” programs as described above.
3. There are transplant centers that have paired exchange programs that are not affiliated with any of the three “co-op” organizations. You could register at these transplant centers too.
   

Registering with many paired exchange programs may not be easy, but it will increase the odds of being matched with another incompatible pair.

For a more detailed description of Paired exchanges click here or go to: www.lkdn.org/LKDN_Paired_Exchanges.pdf

Click here for a printable version.