Efforts to Increase Living Donor Kidney Donations and General Transplants

According to the National Kidney Foundation, there are more than 100,000 patients currently awaiting a kidney transplant in the United States. Of those, only 17 percent will receive a kidney transplant this year and 13 people who are actively awaiting transplant will die every day. With live donors historically being limited to family members or close friends of the recipient, and deceased donor numbers remaining relatively static, the following four pragmatic innovations were created over the past two decades to increase the number of living donor options.

1. Paired Donations. In a traditional paired donation scenario, an original donor provides the allograft for a non-related recipient. The proposed donor for that recipient, in turn, donates a kidney to the original donor’s chosen recipient. While two-way donations have been the most common scenario under a paired donation exchange, larger (three- and four-way) exchanges have occasionally come to fruition.

2. Altruistic Donations. In other cases, anonymous or altruistic donors have volunteered to donate a kidney in a non-directed fashion to a stranger. In such situations, the selfless act of the donor either allows for a patient on the kidney transplant wait list to receive a living donor organ, or allows for a paired donation that would have otherwise been hindered by bio-incompatibility.

3. Waiting List Donations. Another option for living donors who are incompatible with their loved ones is to donate their organ to the waiting list. In this situation, the donor provides a living kidney to the next suitable patient on the wait list. In exchange, the donor’s intended recipient moves to a higher position on the deceased donor waiting list. While in a paired donation scenario, both (or all) recipients receive a living donor kidney, in this particular situation, one individual will receive a living donor kidney, while the other will move near the top of the waiting list and receive a deceased donor kidney.

4. Kidney “Chain” Donations. More recently, the concept of kidney “chains” have developed. These chains typically start with an altruistic donor, setting off a cascade effect of ongoing donor/allograft surgeries among strangers, often encompassing several states, medical centers and months. Some chains have led to remarkable numbers of transplants. In early 2015, the University of Wisconsin completed a 34-recipient chain. Later that year, the University of Alabama participated in a 51-recipient chain.

Meeting the needs of an ever-expanding list awaiting a renal transplant requires innovative thinking that disrupts the status quo. Since its inception, the National Kidney Registry has led the efforts in kidney chain donation and has facilitated nearly 2,000 transplants to date. The Living Kidney Donor Network refers to this type of donation as a “Domino Paired Exchange.” Regardless of who provides the logistics for these chains, shared knowledge, enhanced resources and improved allocation are serving to increase access and grant a new lease on life to thousands of patients awaiting a kidney.

While organizations have worked to increase the number of living donor options, the U.S. Department of Health & Human Services sponsored a three-year study (2017–2019), the Collaborative Improvement Innovation Project (COIIN), to increase the number of overall transplants, primarily through a focus on deceased donor kidneys. COIIN aims to:

• Reduce the risk-avoidance behaviors that are associated with current monitoring system
• Remove current performance flagging criteria for participating kidney transplant programs
• Develop and test alternative data-rich quality monitoring frameworks
• Support a collaborative approach toward performance improvement and best practices

As a part of the study, dialysis providers across the United States, including DaVita, are working with several premier transplant programs to make significant strides in increasing access to kidney transplants for their patients.