Foundations and principles of the Canadian living donor paired exchange program

PURPOSE OF REVIEW: Kidney paired donation (KPD) remains an important strategy to facilitate transplantation in patients who have a healthy and willing donor, but are unable to proceed with directed donation due to either ABO incompatibility or a positive cross-match against their intended donor. SOURCES OF INFORMATION: Personal knowledge, The Canadian Blood Services Database for Living Donor Exchange, published reports and personal communications. FINDINGS: The national Living Donor Paired Exchange Programme (LDPE) in Canada was established in 2009. 235 transplants were completed of which 190 were registered recipients and 45 were from the deceased donor (DD) wait list. At 1 year, patient survival was 100%, graft survival 98%, with a biopsy proven acute rejection rate of 8%. The mean serum creatinine (Cr) at the end of one year was 109 mmol/l. Donor survival is 100%. Key to success are national standards for antibody testing and cross-matching, and for evaluating donors and recipients, as well infrastructure (software and personnel) to run the program. The structure of the Canadian program is compared with that of other programs in the United Kingdom, Australia, the Netherlands, and the United States. LIMITATIONS: This review does not include information on travel distances and difficulties, or patient satisfaction. IMPLICATIONS: National collaboration and acceptance of common standards is possible and leads to substantial benefits, especially for those patients who are hardest to match. What was known before: Kidney paired donation is considered ethically acceptable. National and regional programs have been created in a number of countries. What this paper adds: Key to the success of the Canadian national program are acceptance of standardized procedures and national and provincial support and oversight.