In Search of a Better Outcome: Opting Into the Live Donor Paired Kidney Exchange Program
Background: Live donor (LD) kidney transplantation is the best option for patients with end-stage kidney disease (ESKD). However, this may not be the best option if a patient’s donor is older and considerably smaller in weight. Patient (A) with a less than ideal donor (Donor A) might enter into a li...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2021-05-01
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| Series: | Canadian Journal of Kidney Health and Disease |
| Online Access: | https://doi.org/10.1177/20543581211017412 |
| _version_ | 1818612455662682112 |
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| author | Amanda J. Vinson Bryce A. Kiberd Karthik K. Tennankore |
| author_facet | Amanda J. Vinson Bryce A. Kiberd Karthik K. Tennankore |
| author_sort | Amanda J. Vinson |
| collection | DOAJ |
| description | Background: Live donor (LD) kidney transplantation is the best option for patients with end-stage kidney disease (ESKD). However, this may not be the best option if a patient’s donor is older and considerably smaller in weight. Patient (A) with a less than ideal donor (Donor A) might enter into a live donor paired exchange (LDPE) program with the hopes of swapping for a better-quality organ. A second patient (B) who is in the LDPE may or may not benefit from this exchange with Donor A. Methods: This medical decision analysis examines the conditions that favor Patient A entering into the LDPE compared to directly accepting a kidney from their intended donor, as well as the circumstances where Patient B also benefits by accepting a lower-quality organ. Results: Under select circumstances, a paired exchange could benefit both Patients A and B. For example, a 30-year-old Patient A with a lower-quality donor might gain 1.20 1.52 1.84 quality adjusted life years (QALYs) by entering into a LDPE for a better-quality kidney, whereas a 60-year-old Patient B might gain 0.93 1.03 1.13 QALYs by accepting Donor A’s kidney rather than waiting longer in the LDPE. The net benefit (or loss) of entering the LDPE differs by recipient age, donor organ quality, likelihood of Patient B being transplanted in LDPE, and likelihood of Patient A finding an ideal donor in the LDPE. Conclusion: This study shows there are ways to increase live donor utilization and effectiveness that require further research and potentially changes to the LDPE process. |
| first_indexed | 2024-12-16T15:46:30Z |
| format | Article |
| id | doaj.art-415f35c27f434abeac27c7ba9d52d464 |
| institution | Directory Open Access Journal |
| issn | 2054-3581 |
| language | English |
| last_indexed | 2024-12-16T15:46:30Z |
| publishDate | 2021-05-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Canadian Journal of Kidney Health and Disease |
| spelling | doaj.art-415f35c27f434abeac27c7ba9d52d4642022-12-21T22:25:47ZengSAGE PublishingCanadian Journal of Kidney Health and Disease2054-35812021-05-01810.1177/20543581211017412In Search of a Better Outcome: Opting Into the Live Donor Paired Kidney Exchange ProgramAmanda J. Vinson0Bryce A. Kiberd1Karthik K. Tennankore2Department of Medicine, Dalhousie University, Halifax, NS, CanadaDepartment of Medicine, Dalhousie University, Halifax, NS, CanadaDepartment of Medicine, Dalhousie University, Halifax, NS, CanadaBackground: Live donor (LD) kidney transplantation is the best option for patients with end-stage kidney disease (ESKD). However, this may not be the best option if a patient’s donor is older and considerably smaller in weight. Patient (A) with a less than ideal donor (Donor A) might enter into a live donor paired exchange (LDPE) program with the hopes of swapping for a better-quality organ. A second patient (B) who is in the LDPE may or may not benefit from this exchange with Donor A. Methods: This medical decision analysis examines the conditions that favor Patient A entering into the LDPE compared to directly accepting a kidney from their intended donor, as well as the circumstances where Patient B also benefits by accepting a lower-quality organ. Results: Under select circumstances, a paired exchange could benefit both Patients A and B. For example, a 30-year-old Patient A with a lower-quality donor might gain 1.20 1.52 1.84 quality adjusted life years (QALYs) by entering into a LDPE for a better-quality kidney, whereas a 60-year-old Patient B might gain 0.93 1.03 1.13 QALYs by accepting Donor A’s kidney rather than waiting longer in the LDPE. The net benefit (or loss) of entering the LDPE differs by recipient age, donor organ quality, likelihood of Patient B being transplanted in LDPE, and likelihood of Patient A finding an ideal donor in the LDPE. Conclusion: This study shows there are ways to increase live donor utilization and effectiveness that require further research and potentially changes to the LDPE process.https://doi.org/10.1177/20543581211017412 |
| spellingShingle | Amanda J. Vinson Bryce A. Kiberd Karthik K. Tennankore In Search of a Better Outcome: Opting Into the Live Donor Paired Kidney Exchange Program Canadian Journal of Kidney Health and Disease |
| title | In Search of a Better Outcome: Opting Into the Live Donor Paired Kidney Exchange Program |
| title_full | In Search of a Better Outcome: Opting Into the Live Donor Paired Kidney Exchange Program |
| title_fullStr | In Search of a Better Outcome: Opting Into the Live Donor Paired Kidney Exchange Program |
| title_full_unstemmed | In Search of a Better Outcome: Opting Into the Live Donor Paired Kidney Exchange Program |
| title_short | In Search of a Better Outcome: Opting Into the Live Donor Paired Kidney Exchange Program |
| title_sort | in search of a better outcome opting into the live donor paired kidney exchange program |
| url | https://doi.org/10.1177/20543581211017412 |
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