Kidney paired / pooled sharing
Donor-recipient pairs who are incompatible by Human Lymphocyte Antigen (HLA) type or ABO blood group and unable to donate directly, one to the other, are registered in a national scheme to achieve compatible transplants with other pairs.
When two donor pairs are involved it is called 'paired' donation. If there is more than two pairs, it is called 'pooled' donation. (Figure 1). Compatible donor-recipient pairs who seek a better HLA or age match may also be registered in the scheme.
Living Donor Kidney Matching Runs
Living Donor Kidney Matching Runs (LDKMR) are performed 4 times per year, in January, April, July and October. All donors and recipients who are registered in the NLDKSS and entered into the LDKMR are eligible for inclusion. Each LDKMR identifies paired/pooled exchanges and altruistic donor chains in optimal combinations, which are reported to transplant centres on the matching run report. To increase the potential of the PPD scheme, the following improvements were introduced in January 2012:
Prioritisation criteria including:
- No priority for local exchanges
- No restriction on the allocation of blood group 'O' kidneys
- Incremental prioritisation for recipients who remain unmatched in the scheme after each LDKMR
- Compatible donor-recipient pairs are eligible for the scheme
- Extended matching criteria form for registering patients with low titre HLA and ABO blood group antibodies
- Specification of special considerations relating to the donor +/- kidney to be donated that are relevant to the acceptance of a donated kidney
- A confirmation of inclusion report to ensure that specific criteria have been met by the transplant centre prior to including each donor-recipient pair in the LDKMR
Summary of Arrangements for Paired/Pooled Donation (PPD)
- Donor and recipient assessment and preparation for donation and transplantation as per UK Guidelines and local transplant centre protocol. For more information, see the British Transplantation Society Standards and Guidelines.
- When assessment complete, donor and recipient registration with Organ Donation and Transplantation (ODT), NHS Blood and Transplant (NHSBT). Deadlines for registration of new pairs in the scheme are provided by Organ Donation and Transplantation (ODT) and circulated via named living donor co-ordinator (LDC) and histocompatibility and immunology (H&I) contacts in transplant centres.
- 'Confirmation of Inclusion report' sent to named LDC and H&I contacts in transplant centres prior to LDKMR to positively confirm all eligible pairs for inclusion in the LDKMR and co-ordinate responses from across regional networks. Confirmation of inclusion to ODT to be made by named LDC transplant centre contact up to 12 working days prior to the LDKMR.
- 10 working days prior to LDKMR, special considerations relating to donor +/- kidney that are relevant to the acceptance of a donor kidney by the recipient centre circulated by ODT to named LDC contacts. Clinical teams to agree acceptance or refusal of a potential donor kidney if matched to an identified recipient. LDC contacts to report decision to ODT by LDKMR deadline specified by ODT (usually 1 day prior to LDKMR).
- LDKMR performed by ODT in conjunction with the University of Glasgow to identify suitable pairs in optimal exchanges - see LDKMR matching process. 'Matching Run Report' sent to named LDC and H&I contacts in transplant centres for dissemination and co-ordination across regional networks.
- Recipients identified in possible paired/pooled exchanges suspended from national transplant list by ODT until initial immunological crossmatch results confirm compatibility of all pairs. Crossmatch testing - see donor blood sample requirements by centre in paired donation, to be co-ordinated by the named LDC and H&I contacts and results notified to ODT (ideally within 7-14 days of LDKMR)
- There are designated weeks of surgery in the 6-8 weeks following a matching run. This is to help coordination across transplant centres and to try to ensure timely transplantation following identification of a match. While most surgery is simultaneous, there is flexibility to allow non-simultaneous surgery within the scheme to accommodate logistical delays for non-clinical reasons. Requests for non-simultaneous surgery should be directed through the Lead Nurse for Living Donation.
For suitable pairs
- Human Tissue Authority (HTA) approval process via local Independent Assessor and HTA panel.
- Date of surgery scheduled between centres to facilitate simultaneous surgery for all pairs, to conform to clinical standard of 8 weeks from notification of matches to scheduling of surgery.
- Final crossmatch tests according to agreed protocol prior to scheduled date of surgery.
- Suitable storage and transport of kidneys arranged by named LDC contacts in transplant centres.
- Anonymity of pairs respected throughout unless all parties wish to break it via the LDCs after surgery.
- Date of transplant confirmed to ODT post surgery by named LDC contacts
For unsuitable pairs
- Re-activation on national transplant list by ODT and local leads.
- Registration for PPD 'carried over' pending confirmation of inclusion for next LDKMR.
Relevant patient associations and charities are listed under external links.