Donor Exchange for Renal Transplantation

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Abstract
The Perspective article by Delmonico (April 29 issue)1 prompts us to report on the Dutch Living Donor Kidney Exchange program. Since January 1, 2004, all seven transplantation centers in the Netherlands have cooperated in this common protocol. The Dutch Transplant Foundation is responsible for allocation on an anonymous basis, the approach generally preferred by our patients.2 Allocation is determined according to the following hierarchy of factors: blood type (first identical, and then compatible); match probability (derived from the prevalence of HLA antigens in the kidney-exchange donor pool and the unacceptable HLA antigens of the recipient); and then the wait time (calculated beginning with the first day of renal-replacement therapy).3 Since the start of this program, 32 pairs have applied to participate. The median wait time was 2.5 years (range, 0.0 to 5.0), and the median peak level of preformed antibodies at the time of application was 14 percent (range, 0 to 100). There were 13 pairs with blood-type incompatibility and 19 pairs with cross-match incompatibility. There were new combinations in 14 of the pairs (44 percent) — specifically, in 6 of the 13 pairs with blood-type incompatibility and in 8 of the 19 pairs with cross-match incompatibility.

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