Skip to main navigation menu Skip to main content Skip to site footer

Review article: Biomedical intelligence

Vol. 145 No. 0910 (2015)

Kidney paired donation: a plea for a Swiss National Programme

  • Karine Hadaya
  • Thomas Fehr
  • Barbara Rüsi
  • Sylvie Ferrari-Lacraz
  • Jean Villard
  • Paolo Ferrari
Cite this as:
Swiss Med Wkly. 2015;145:w14083


Growing incidence of end-stage renal disease, shortage of kidneys from deceased donors and a better outcome for recipients of kidneys from living donor have led many centres worldwide to favour living donor kidney transplantation programmes. Although criteria for living donation have greatly evolved in recent years with acceptance of related and unrelated donors, an immunological incompatibility, either due to ABO incompatibility and/or to positive cross-match, between a living donor and the intended recipient, could impede up to 40% of such procedures. To avoid refusal of willing and healthy living donors, a number of strategies have emerged to overcome immunological incompatibilities. Kidney paired donation is the safest way for such patients to undergo kidney transplantation. Implemented with success in many countries either as national or multiple regional independent programmes, it could include simple exchanges between any number of incompatible pairs, incorporate compatible pairs and non-directed donors (NDDs) to start a chain of compatible transplantations, lead to acceptance of ABO-incompatible matching, and integrate desensitising protocols. Incorporating all variations of kidney paired donation, the Australian programme has been able to facilitate kidney transplantation in 49% of registered incompatible pairs. This review is a plea for implementing a national kidney paired donation programme in Switzerland.


  1. Oniscu GC, Brown H, Forsythe JL. Impact of cadaveric renal transplantation on survival in patients listed for transplantation. J Am Soc Nephrol. 2005;16:1859–65.
  2. Watson CJ, Dark JH. Organ transplantation: historical perspective and current practice. Br J Anaesth. 2012;108(Suppl 1):i29–42.
  3. Terasaki PI, Cecka JM, Gjertson DW, et al. High survival rates of kidney transplants from spousal and living unrelated donors. N Engl J Med. 1995;333:333–6.
  4. Meier-Kriesche HU, Kaplan B. Waiting time on dialysis as the strongest modifiable risk factor for renal transplant outcomes: a paired donor kidney analysis. Transplantation. 2002;74:1377–81.
  5. Harter TD. Overcoming the organ shortage: failing means and radical reform. HEC Forum. 2008;20:155–82.
  6. Karpinski M, Knoll G, Cohn A, et al. The impact of accepting living kidney donors with mild hypertension or proteinuria on transplantation rates. Am J Kidney Dis. 2006;47:317–23.
  7. Tanabe K. Japanese experience of ABO-incompatible living kidney transplantation. Transplantation. 2007;84(12 Suppl):S4–7.
  8. Tyden G, Kumlien G, Genberg H, et al. ABO incompatible kidney transplantations without splenectomy, using antigen-specific immunoadsorption and rituximab. Am J Transplant. 2005;5:145–8.
  9. Flint SM, Walker RG, Hogan C, et al. Successful ABO-incompatible kidney transplantation with antibody removal and standard immunosuppression. Am J Transplant. 2011;11:1016–24.
  10. Bentall A, Cornell LD, Gloor JM, et al. Five-year outcomes in living donor kidney transplants with a positive crossmatch. Am J Transplant. 2013;13:76–85.
  11. Vo AA, Peng A, Toyoda M, et al. Use of intravenous immune globulin and rituximab for desensitization of highly HLA-sensitized patients awaiting kidney transplantation. Transplantation. 2010;89:1095–102.
  12. Gloor JM, Winters JL, Cornell LD, et al. Baseline donor-specific antibody levels and outcomes in positive crossmatch kidney transplantation. Am J Transplant. 2010;10:582–9.
  13. Montgomery RA, Lonze BE, King KE, et al. Desensitization in HLA-incompatible kidney recipients and survival. N Engl J Med. 2011;365:318–26.
  14. Bostock IC, Alberu J, Arvizu A, et al. Probability of deceased donor kidney transplantation based on % PRA. Transpl Immunol. 2013;28:154–8.
  15. Neumayer HH, Budde K, Liefeldt L. Human Leukocyte Antigen-Incompatible Kidney Transplantation After “Desensitization”-Hope and Reality. Transplantation. 2014:(ePub).
  16. de Klerk M, Keizer KM, Claas FH, et al. The Dutch national living donor kidney exchange program. Am J Transplant. 2005;5:2302–5.
  17. Ferrari P, De Klerk M. Paired kidney donations to expand the living donor pool. J Nephrol. 2009;22:699–707.
  18. Ferrari P, Weimar W, Johnson RJ, et al. Kidney Paired Donation: Principles, Protocols and Programs. Nephrol Dial Transplantation. 2014:(in press).
  19. Rapaport FT. The case for a living emotionally related international kidney donor exchange registry. Transplant Proc. 1986;18(3 Suppl 2):5–9.
  20. Kwak JY, Kwon OJ, Lee KS, et al. Exchange-donor program in renal transplantation: a single-center experience. Transplant Proc. 1999;31:344–5.
  21. Park K, Lee JH, Huh KH, et al. Exchange living-donor kidney transplantation: diminution of donor organ shortage. Transplant Proc. 2004;36:2949–51.
  22. Lucan M. Five years of single-center experience with paired kidney exchange transplantation. Transplant Proc. 2007;39:1371–5.
  23. Lucan M, Rotariu P, Neculoiu D, et al. Kidney exchange program: a viable alternative in countries with low rate of cadaver harvesting. Transplant Proc. 2003;35:933–4.
  24. Gurkan A, Kacar SH, Varilsuha C, et al. Exchange kidney transplantation: a good solution in living kidney transplantation. Transplant Proc. 2004;36:2952–3.
  25. Kacar SH, Eroglu A, Tilif S, et al. A novel experience in living donor renal transplantation: voluntary exchange kidney transplantation. Transplant Proc. 2013;45:2106–10.
  26. Gumber MR, Kute VB, Goplani KR, et al. Transplantation with kidney paired donation to increase the donor pool: a single-center experience. Transplant Proc. 2011;43:1412–4.
  27. Kute VB, Gumber MR, Patel HV, et al. Outcome of kidney paired donation transplantation to increase donor pool and to prevent commercial transplantation: a single-center experience from a developing country. Int Urol Nephrol. 2013;45:1171–8.
  28. Kute VB, Vanikar AV, Gumber MR, et al. Successful three-way kidney paired donation with compatible pairs to increase donor pool. Ren Fail. 2014;36:447–50.
  29. Segev DL, Gentry SE, Warren DS, et al. Kidney paired donation and optimizing the use of live donor organs. JAMA. 2005;293:1883–90.
  30. Hanto RL, Reitsma W, Delmonico FL. The development of a successful multiregional kidney paired donation program. Transplantation. 2008;86:1744–8.
  31. Rees MA, Bargnesi D, Samy K, et al. Altruistic donation through the Alliance for Paired Donation. Clin Transpl. 2009:235–46.
  32. Veale J, Hil G. The National Kidney Registry: 175 transplants in one year. Clin Transpl. 2011:255–78.
  33. Bingaman AW, Wright FH, Jr., Kapturczak M, et al. Single-Center Kidney Paired Donation: The Methodist San Antonio Experience. Am J Transplant. 2012;12:2125–32.
  34. de Klerk M, Witvliet MD, Haase-Kromwijk BJ, et al. Hurdles, barriers, and successes of a national living donor kidney exchange program. Transplantation. 2008;86:1749–53.
  35. de Klerk M, van der Deijl WM, Witvliet MD, et al. The optimal chain length for kidney paired exchanges: an analysis of the Dutch program. Transpl Int. 2010;23:1120–25.
  36. Johnson RJ, Allen JE, Fuggle SV, et al. Early experience of paired living kidney donation in the United kingdom. Transplantation. 2008;86:1672–7.
  37. Malik S, Cole E. Foundations and principles of the Canadian Living Donor Paired Exchange Program. Can J Kidney Health Dis. 2014; 1:ePub.
  38. Ferrari P, Hughes PD, Cohney SJ, et al. ABO-incompatible matching significantly enhances transplant rates in kidney paired donation. Transplantation. 2013;96:821–6.
  39. Ferrari P, Fidler S, Holdsworth R, et al. High Transplant Rates of Highly-Sensitised Recipients with Virtual Crossmatching in Kidney Paired Donation. Transplantation. 2012;94:744–9.
  40. Ferrari P, Fidler S, Wright J, et al. Virtual Crossmatch Approach to Maximize Matching in Paired Kidney Donation. Am J Transplant. 2011;11:272–78.
  41. Ferrari P, Woodroffe C, Christiansen FT. Paired kidney donations to expand the living donor pool: the Western Australian experience. Med J Aust. 2009;190:700–3.
  42. Thiel G, Vogelbach P, Gurke L, et al. Crossover renal transplantation: hurdles to be cleared! Transplant Proc. 2001;33:811–6.
  43. Ferrari P, Fidler S, Woodroffe C, et al. Comparison of time on the deceased donor kidney waitlist versus time on the kidney paired donation registry in the Australian program. Transplant Int. 2012;25:1026–1031.
  44. Keizer KM, de Klerk M, Haase-Kromwijk BJ, et al. The Dutch algorithm for allocation in living donor kidney exchange. Transplant Proc. 2005;37:589–91.
  45. Montgomery RA, Zachary AA, Ratner LE, et al. Clinical results from transplanting incompatible live kidney donor/recipient pairs using kidney paired donation. JAMA. 2005;294:1655–63.
  46. Saidman SL, Roth AE, Sonmez T, et al. Increasing the opportunity of live kidney donation by matching for two- and three-way exchanges. Transplantation. 2006;81:773–82.
  47. Ross LF, Woodle ES. Ethical issues in increasing living kidney donations by expanding kidney paired exchange programs. Transplantation. 2000;69:1539–43.
  48. Stegall MD, Dean PG, Gloor JM. ABO-incompatible kidney transplantation. Transplantation. 2004;78:635–40.
  49. Kranenburg LW, Zuidema W, Weimar W, et al. One donor, two transplants: willingness to participate in altruistically unbalanced exchange donation. Transpl Int. 2006;19:995–9.
  50. Rizzari MD, Suszynski TM, Gillingham KJ, et al. Consideration of donor age and human leukocyte antigen matching in the setting of multiple potential living kidney donors. Transplantation. 2011;92:70–5.
  51. Wiebe C, Pochinco D, Blydt-Hansen TD, et al. Class II HLA epitope matching – A strategy to minimize de novo donor-specific antibody development and improve outcomes. Am J Transplant. 2013;13(12):3114–22.
  52. Fuggle SV, Allen JE, Johnson RJ, et al. Factors affecting graft and patient survival after live donor kidney transplantation in the UK. Transplantation. 2010;89:694–701.
  53. Gentry SE, Segev DL, Simmerling M, et al. Expanding kidney paired donation through participation by compatible pairs. Am J Transplant. 2007;7:2361–70.
  54. Matas AJ, Garvey CA, Jacobs CL, et al. Nondirected donation of kidneys from living donors. N Engl J Med. 2000;343:433–6.
  55. Bramstedt KA, Dave S. The silence of Good Samaritan kidney donation in Australia: a survey of hospital websites. Clin Transplant. 2013;27:244–8.
  56. Rees MA, Kopke JE, Pelletier RP, et al. A nonsimultaneous, extended, altruistic-donor chain. N Engl J Med. 2009;360:1096–101.
  57. Roodnat JI, Zuidema W, van de Wetering J, et al. Altruistic donor triggered domino-paired kidney donation for unsuccessful couples from the kidney-exchange program. Am J Transplant. 2010;10:821–7.
  58. Montgomery RA, Gentry SE, Marks WH, et al. Domino paired kidney donation: a strategy to make best use of live non-directed donation. Lancet. 2006;368:419–21.
  59. Roth AE, Sonmez T, Unver MU, et al. Utilizing list exchange and nondirected donation through “chain” paired kidney donations. Am J Transplant. 2006;6:2694–705.
  60. Woodle ES, Daller JA, Aeder M, et al. Ethical considerations for participation of nondirected living donors in kidney exchange programs. Am J Transplant. 2010;10:1460–7.
  61. Mierzejewska B, Durlik M, Lisik W, et al. Current approaches in national kidney paired donation programs. Ann Transplant. 2013;18:112–24.
  62. Wallis CB, Samy KP, Roth AE, et al. Kidney paired donation. Nephrol Dial Transplant. 2011;26:2091–9.
  63. Montgomery RA, Lonze BE, Jackson AM. Using donor exchange paradigms with desensitization to enhance transplant rates among highly sensitized patients. Curr Opin Organ Transplant. 2011;16:439–43.
  64. Leeser DB, Aull MJ, Afaneh C, et al. Living donor kidney paired donation transplantation: experience as a founding member center of the National Kidney Registry. Clin Transplant. 2012;26:E213–22.
  65. Sharif A, Zachary AA, Hiller J, et al. Rescue kidney paired donation as emergency salvage for failed desensitization. Transplantation. 2012;93:27–9.
  66. Roodnat JI, van de Wetering J, Claas FH, et al. Persistently low transplantation rate of ABO blood type O and highly sensitised patients despite alternative transplantation programs. Transpl Int. 2012;25:987–93.
  67. de Klerk M, Witvliet MD, Haase-Kromwijk BJ, et al. A highly efficient living donor kidney exchange program for both blood type and crossmatch incompatible donor-recipient combinations. Transplantation. 2006;82:1616–20.
  68. Baxter-Lowe LA, Cecka M, Kamoun M, et al. Center-Defined Unacceptable HLA Antigens Facilitate Transplants for Sensitized Patients in a Multi-Center Kidney Exchange Program. Am J Transplant. 2014;14:1592–8.
  69. Garonzik-Wang JM, Sullivan B, Hiller JM, et al. International kidney paired donation. Transplantation. 2013;96:55–6.
  70. Montgomery RA. Renal transplantation across HLA and ABO antibody barriers: integrating paired donation into desensitization protocols. Am J Transplant. 2010;10:449–57.
  71. Yabu JM, Pando MJ, Busque S, et al. Desensitization combined with paired exchange leads to successful transplantation in highly sensitized kidney transplant recipients: strategy and report of five cases. Transplant Proc. 2013;45:82–7.
  72. Blumberg JM, Gritsch HA, Reed EF, et al. Kidney paired donation in the presence of donor-specific antibodies. Kidney Int. 2013;84:1009–16.

Most read articles by the same author(s)