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Nationwide system of paired exchanges would increase kidneys, reduce waiting time for a donor.

A nationwide system of paired direct and indirect kidney exchanges could substantially increase the number of kidneys available for transplantation each year in the United States and reduce waiting times, according to Stefanos Zenios, a researcher from the Stanford (CA) Graduate School of Business.

Working with Lainie Ross, PhD, a medical ethicist at the University of Chicago (IL), and Steve Woodle, MD, a transplant surgeon from the University of Cincinnati (OH), Zenios tackled the problem of blood type incompatibility, developing a computer model of a system the researchers believe could add 10% more kidneys to the pool every year.

The team first looked at paired exchanges in which, for example, a type A donor would give a kidney to a type A recipient, and in exchange, the recipient's spouse would give a kidney to the first donor's spouse. But the model showed that such a system would increase the number of available kidneys by only 1%, since some blood types are easier to match than others. So the investigators also modeled indirect exchanges, in which a donor offers a kidney to someone on the cadaver kidney waiting list. In exchange, the donor's relative gets high priority for the next cadaver kidney.

Indirect exchanges are necessary for type O recipients, Zenios said. "For example, if a recipient is type O, and the living donor is type A, then for a direct exchange you would need to have a pair with the exact opposite blood types. But since type O donors can give to anyone, that pair would never appear. The only solution is to do an indirect exchange with a patient on the cadaver waiting list."

Zenios and associates estimate that the use of direct and indirect exchanges would make 800 to 1500 additional kidneys available for transplantation each year. "Patients who have a direct exchange will only have to wait a couple of months, as opposed to 3 to 4 years, and those left on the cadaver waiting list will have their waiting times decreased by an average of 6 months," Zenios predicted. He said his proposal is similar to the Hope through Sharing Program at the New England Medical Center in Boston, MA (see Transplant News, April 30).
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Comment:Nationwide system of paired exchanges would increase kidneys, reduce waiting time for a donor.
Publication:Transplant News
Article Type:Brief Article
Geographic Code:1USA
Date:Jun 30, 2001
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