Paired Exchanges
How Incompatible Donors Save Lives

Paired Exchanges, also referred to as swaps or Kidney Paired Donations, are an excellent option for recipients and donors who are not compatible. Each year, the number of paired exchanges is increasing and becoming a larger share of all living kidney transplants.

Paired exchanges have also allowed a donor who doesn’t know someone who needs a kidney transplant, but wants to donate, to save the life of not just one person but many. These transplants are called “domino paired exchanges or “ongoing paired exchanges.” These paired exchanges will be described in more detail in this document.

These individuals are referred to as non-directed donors and when they get involved in a paired exchange, they increase the number of paired exchanges that are performed. This is a tremendous help to you if you have an incompatible donor. When non-directed donors are asked why they want to donate their kidney, they often say: “when I learned that so many people needed a transplant I decided to donate”.

So being educated about living kidney transplants and how they could save a life, motivated them to donate. They weren’t born kidney donors. They were educated and then acted. That’s what you’ll be doing with your campaign, educating people about your need and living kidney transplants and how they save lives.

How Does a Paired Exchange Work?
A paired exchange consists of two or more donor/recipient pairs who are not compatible with each other. Paired exchanges are a major breakthrough in living donations and are revolutionizing living donor transplants by eliminating incompatibility as a barrier to donation. This option provides a way for recipients and their incompatible donors to be paired with another, or more than one incompatible recipient and donor.

In the above illustration, Donor 1 is not compatible with Recipient 1, and Donor 2 is not compatible with Recipient 2. However, Donor 1 is compatible with Recipient 2 and Donor 2 is compatible with Recipient 1. If you have a donor who is not compatible with you, and they are willing to participate in a paired exchange, you can be paired with another incompatible pair. This example used 2 pairs, but any number of pairs is possible.

Domino Paired Exchanges – The Power of Non-Directed Donors (NDD)

A Domino paired exchange starts with a NDD. Someone who is interested in donating but doesn’t know an individual in need. Instead of just one person benefiting from the NDD gift, many recipients with an incompatible donor can benefit. The difference in the illustration shown below from the paired exchange from above is that Donor #2 is not compatible with either recipient #1 or #2. As such, the non-directed donor allows the other pairs to be exchanged, and have a “domino” effect. With the extra donor another recipient can benefit, that recipient will come from the national kidney transplant waiting list. This example uses 3 pairs, but there isn’t a limit to the number of pairs that could participate.

Ongoing Donor Chains (Also called Never Ending Donor Chains)
A NDD can initiate donor chains that have the potential of benefiting an unlimited number of recipients.
In the example below, donor, #2 does not donate in this exchange. Donor #2 is referred to as the “bridge donor” for the next “chain” of transplants. Donor #2 functions in the same role as the NDD in this example and starts another chain. These chains could continue, over and over again with a new bridge donor each time. This example uses 2 pairs and the NDD, but any number of pairs could be transplanted in each chain.

Compatible Paired Exchanges
In a compatible paired exchange, the donor and recipient are compatible, but are interested in becoming part of a paired exchange. The recipient of that pair will usually benefit by at least one of the following as an incentive for compatible pairs to get involved in a paired exchange:

1. Their new donor could be much younger than their current donor.
   
2. The new donor’s kidney may be a better size for them. i.e. they may weigh 190 pounds and their donor weighs 110 pounds…the new donor may weigh 180 pounds.
3. The new donor may be a better HLA (Human Leukocyte Antigen) or even perfectly matched which would significantly increase the longevity of the transplant.

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