Utilizing list exchange and nondirected donation through 'chain' paired kidney donations

Am J Transplant. 2006 Nov;6(11):2694-705. doi: 10.1111/j.1600-6143.2006.01515.x. Epub 2006 Sep 18.


In a list exchange (LE), the intended recipient in an incompatible pair receives priority on the deceased donor waitlist (DD-waitlist) after the paired incompatible donor donates a kidney to a DD-waitlist candidate. A nondirected donor's (ND-D) kidney is usually transplanted directly to a DD-waitlist candidate. These two established practices would help even more transplant candidates if they were integrated with kidney paired donation (KPD). We consider a scenario in which the donor of an LE intended recipient (LE-IR) donates to a compatible KPD intended recipient (KPD-IR), and the KPD donor (KPD-D) donates to the waitlist (an LE-chain). We consider a similar scenario in which an ND-D donates to a KPD-IR and the KPD-D donates to the DD-waitlist (an ND-chain). Using data derived from the New England Program for Kidney Exchange (NEPKE) and from OPTN/SRTR recipient-donor distributions, simulations are presented to evaluate the potential impact of chain exchanges coordinated with KPD. LE donors (LE-D) and ND-D who are ABO-O result in the highest number of additional transplants, while results for ABO-A and B donors are similar to each other. We recommend that both LE and ND donations be utilized through chain exchanges.

MeSH terms

  • ABO Blood-Group System
  • Blood Group Incompatibility
  • Computer Simulation
  • Humans
  • Kidney Transplantation / immunology*
  • Kidney*
  • Lewis Blood Group Antigens
  • Tissue Donors / statistics & numerical data*
  • Tissue and Organ Procurement / methods*
  • Waiting Lists*


  • ABO Blood-Group System
  • Lewis Blood Group Antigens