BACKGROUND It has been suggested that deceased donor kidneys could be used to initiate chains of living donor kidney paired donation (KPD), but the potential gains of this practice need… Click to show full abstract
BACKGROUND It has been suggested that deceased donor kidneys could be used to initiate chains of living donor kidney paired donation (KPD), but the potential gains of this practice need to be quantified and the ethical implications must be addressed before it can be implemented. METHODS The gain of implementing deceased-donor-initiated chains was measured with an algorithm, using retrospective data on the pool of incompatible donor/recipient pairs, at a single center. The allocation rules for chain-ending kidneys and the characteristics and quality of the chain-initiating kidney (CIK) are described. RESULTS The benefit quantification process showed that, with a pool of 69 kidneys from deceased donors and 16 pairs enrolled in the KPD program, it was possible to transplant 8/16 recipients (50%) over a period of 3 years. After obtaining the approval of the Veneto Regional Authority's Bioethical Committee and the revision of the Italian National Transplant Center's allocation policies, the first successful case was completed. For the recipient (male, 53 yo), who entered the program for a CIK with a kidney donor risk index (KDRI) of 0.61 and a kidney donor profile index (KDPI) of 3%, the waiting time was 4 days. His willing donor (female, 53 yo) with a living kidney donor profile index (LKDPI) of 2, donated 2 days later to a chain-ending recipient (male, 47 yo) who had been on dialysis for 5 years. CONCLUSIONS This is the first report of a successfully-completed, deliberate deceased-donor-initiated chain, which was made possible after a thorough assessment of the ethical issues and the impact of allocation policies. This paper includes a preliminary efficacy assessment and describes the development a dedicated algorithm.
               
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