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April 2009 Issue

New research shows that altruistic kidney donors can set off chain reactions that make transplants possible for many needy recipients.
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Certain Kidney Donors Can Generate More Transplants

By Katie Pence
Published April 2009

A new study using software developed at UC shows that altruistic kidney donors can set off chain reactions that make transplants possible for many needy recipients.

The study was published in the March 12, 2009, edition of the New England Journal of Medicine.

Jonathan Kopke, research associate in the UC department of public health sciences, and his colleagues from around the country assembled a chain that began with one altruistic donor and has resulted in 10 transplants so far.

Kopke says that this idea is an extension of what has come to be known as “kidney paired donation.”

“There are many people who need kidney transplants and who have loved ones willing to donate an organ to them, but those loved ones aren’t suitable donors for them because they’re immunologically incompatible,” Kopke says.

“The paired donation procedure allows us to avoid these problems by arranging for two pairs who are caught in the same dilemma to solve each other’s problems by simply swapping donors.

“However, finding two pairs with complementary incompatibilities is very unlikely statistically speaking.”

He continues, “On the other hand, we discovered that if we started with an altruistic donor, who gave to someone in need purely out of the kindness of his or her heart, the transplant recipient’s loved one could then give a kidney to someone else in the system.

“It’s much easier to find someone who can use a kidney when we aren’t restricted to finding someone who can also give a suitable kidney back. We’re learning that these extended chains of donations can yield many more transplants than simple exchanges ever could.”

Researchers completed this work over the course of six years in hospitals nationwide. Kopke, co-author of the study, says this is the first instance of an extended “altruistic-donor chain” that has been reported. He adds that another advantage of this arrangement is that the necessary surgeries can be done over a period of weeks or months, as opposed to on the same day.

“The rule has always been that the transplants all had to be done simultaneously to avoid the possibility of someone backing out,” Kopke says. “In this case, even if a donor does renege—and that hasn’t happened yet—the rest of the people in the chain aren’t irreparably harmed.”

Kopke says these new findings show that one donor could have the potential to help dozens of people who need a transplant. “Just one generous act could theoretically save hundreds of lives,” he says.

“This type of chain has the potential to really shorten the long waiting lists to receive deceased-donor kidney transplants.

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