Kidney Paired Donation: National Activity and Perspectives

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Medicine and Health Sciences


While utilization of Kidney Paired Donation (KPD) continues to increase, the potential is not fully realized. We surveyed kidney transplant (KTX) professionals to evaluate perceptions of barriers and solutions to increasing KPD and correlated the results with KPD utilization patterns and center volume. Methods: Transplant directors (medical, surgical, HLA), coordinators and administrators from all US KTX programs were invited to complete a 31 question survey in May 2014. Center specific data for 2013 was obtained from UNOS. Results: While only 100 of 225(44%) centers participated in KPD, 22 centers performed 20-50% of their living donor (LD) KTXs via KPD. Survey respondents(N=199) represented 129 centers(57%). 161/199(81%) of respondents were from centers participating in KPD; representing 10/11(91%) of centers performing >100/yr LD KTX, 23/31(74%) performing >50/yr, and 36/87(41%) performing <10/yr. Overall, 55% of respondents felt that their center ‘probably’ or ‘definitely’ underutilized KPD. 88/161(55%) indicated their program participated in more than 1 KPD program. Center KPD volume correlated with the practice of inviting all pairs to participate (p=0.04). Surgeons were most commonly cited as leading their center’s KPD program(34%), with just 16% led by committee. Only 33% said their program dedicated ≥1 FTE to KPD. Lack of patient interest was most often selected as the ‘#1 barrier’. The ‘#1 solution’ selected was the need to optimize one KPD program(27.4%), followed closely by decreasing financial risk(23.7%) and increasing patient education(21.5%). KPD activity was significantly less in non-major vs major metropolitan areas (population of more than 1 million), p=0.034. Conclusion: Utilization of KPD is still limited, with non-involvement of >50% of centers. By increasing patient education, unifying KPD programs, and controlling financial risk, there is the potential to significantly increase LD KTX activity. Some centers routinely utilized KPD, even when located in a non-major metropolitan area. While transplant center location in a major metro area may facilitate KPD utilization, these data suggest other factors influence participation rates. Additional reasons for underutilization of KPD are unclear, and require further analysis.


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