Establishing the Kidney Paired Donation System
UF Health transplant surgeon Kenneth Andreoni, M.D., and the department of surgery are at the forefront of a movement to increase the number of kidney paired donations performed across the U.S.
For these procedures, a patient in need of a kidney can join together with a would-be live donor who is not a match for the patient, and then link up with other donor-recipient pairs to find matches for each recipient. Typically, the procedures are carried out at two or three different hospitals, with a kidney removed from a donor at one site, then flown to a different site and implanted into the local recipient.
This can occur with two, three or even more incompatible donor-recipient pairs, allowing all of these potential recipients to receive new living-donor kidney transplants, even though none could find a directly compatible living donor on their own.
Since 2004, Andreoni, who is an associate professor in UF’s department of surgery, has led the United Network for Organ Sharing working group on kidney paired donations, abbreviated KPDs for short.
The UNOS KPD group has tackled a series of challenges that once prevented kidney paired donation from being commonly used, as outlined in an article in the Winter 2014 issue of the Chimera newsletter published by the American Society of Transplant Surgeons. The group joined with others to overcome a legal question about KPD by pushing for the passage of a new federal law that would expressly legalize the procedures. President George W. Bush signed the Charlie W. Norwood Living Organ Donation Act in 2007.
Other efforts included launching a national pilot KPD program in 2009, and creating a KPD database within the UNOS electronic system known as UNet. This database became fully functional and integrated into the UNet system in early 2014.
“The national UNOS KPD system is allowing patients with willing but incompatible living donors to experience successful, life-extending kidney transplants in a timely fashion,” noted Andreoni.
“All of the kidney transplant multidisciplinary team members — nephrologists, nurse coordinators, social workers, financial coordinators and surgeons — are deeply involved in the thorough evaluation of the potential donors and recipients in order to make this program available to our patients at UF Health. We have also had excellent cooperation from our surgical team members — anesthesiologists, nurses and technicians — to start operative cases as early as 5 a.m. in order for the organs to make scheduled flights on time.”
Andreoni also credited Ivan Zendejas, M.D., and Elizabeth Thomas, D.O., both assistant professors in the department’s division of transplantation surgery, for their work on “hand-assisted donor nephrectomy and recipient operations.” He recognized Jeffrey Fair, M.D., a professor and chief of the division, for his work on recipient cases, “since the recipient operations must be started as soon as the living donor organs arrive from out of town.”
UF Health transplant providers are taking full advantage of the new system to identify potential matches that can be made through KPDs. Since November 2013, UF Health transplant surgeons have performed several KPDs, working in collaboration with medical centers in five other states to provide numerous patients with new kidneys from living donors.