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TRANSPLANTS
& TRANSFUSION

continued from page 20 Figure 1

2. The chain may end with a donation to Figure 2
someone on the transplant wait list. The
longest chain done at MSTH involved delay a possible transplant.
23 transplants, starting from one altruis- KPD was initially proposed in 1986 by Dr. Felix Rappaport. At
tic donor. Unfortunately these donors are
not common as medical and other factors that time swapping a kidney for another kidney was viewed as illegal
may rule out donation. under the National Organ Transplant Act of 1984 (NOTA). The Jus-
tice Department opined that an exchange was “valuable considera-
A summary of the KPD experience at tion” for an organ and therefore prohibited. The NOTA was
MSTH is shown in Figure 3. Outcomes amended in 2008 to specify that kidney exchange was legal and did
have been excellent and patients have not constitute “valuable consideration.” This allowed the MSTH
achieved a transplant that had been wait-
ing for as long as 14 years on dialysis. It
has been extremely gratifying to be able
to achieve transplants for these difficult
patients who may have had little hope in
the past.

There are other KPD programs in the
U.S. and in other countries. The Na-
tional Kidney Registry (NKR) based in
New York has emphasized altruistic
donors and transplant chains and was
started by the father of a young girl who
needed a kidney. The United Network
for Organ Sharing (UNOS) which man-
ages organ allocation and policy in the
U.S. also has a KPD program open to all
centers. The MSTH in-house approach
has had advantages related to efficiency,
flexibility and control that have made it
uniquely successful. MSTH has also
worked with the NKR, UNOS and other
single center KPD programs to achieve
transplants, exchanging donor kidneys
with other programs in Texas and as far
away as Georgia.

MSTH has been a leader in using compatible pairs to create ex-
change opportunities. In this type of case a donor-recipient pair
is compatible and could proceed with a transplant — say an A re-
cipient with an O donor. However the donor may not be the best
age or size match, for example, and a better transplant may be pos-
sible in an exchange with an incompatible pair. This produces a
win-win situation for both patients who receive transplants. It is
important not to disadvantage the compatible pair and to not

22 San Antonio Medicine • April 2016 continued on page 24