ORGAN DONATION AND ALLOCATION I

R.J. Johnson¹, J. Allen², S.V. Fuggle³, J.A. Bradley^4
1Statistics And Clinical Audit, NHS Blood and Transplant (UK), Bristol/UNITED KINGDOM, ², NHS Blood and Transplant, Bristol/UNITED KINGDOM, ³Scientific Advisor, NHS Blood and Transplant (UK), Bristol/UNITED KINGDOM, ⁴Transplant Surgery, Addenbrooke's Hospital NHS Trust, Cambridge/UNITED KINGDOM

Body: Introduction A new legal framework for organ donation in the UK allowed paired living kidney donation from 2006. A national programme was agreed and the first quarterly ‘matching run’ was possible in April 2007. The scheme initially considered only two-way exchanges, but included three-way exchanges after the first year. All possible exchanges are identified at each matching run, and each set of potential transplants is prioritised according to scoring for individual transplants.
Methods By the end of 2009 over 300 pairs had enrolled in the scheme with 150 pairs included in the first quarterly matching run of 2010. Data on these pairs are summarised and transplant rates and reasons for transplants not proceeding are described. Results Almost 60% of enrolled pairs are HLA incompatible [HLAi] (including 14% also ABO incompatible [ABOi]), while the remainder are ABOi only. All 23 transplant centres in the UK have registered pairs. The degree of sensitisation of HLAi pairs is a limiting factor in identifying potential transplants - 47% of the patients included in the January 2010 matching run had calculated HLA antibody reaction frequencies of 95-100%. Despite this, one third of patients have been identified for a transplant, although over half of these identified transplants have not proceeded due to positive crossmatch results or late identification of either donor issues or alternative transplants. In total, 50 paired donor recipients (16% of enrolled patients) were transplanted through the scheme by February 2010. This includes four three-way exchanges. The pairs most likely to be transplanted through the scheme are A donor / B recipient and vice-versa ABOi pairs (38% transplanted), and HLAi pairs with only low or moderate levels of sensitisation (30%). In all cases, kidneys rather than donors have travelled and the median cold ischaemia time is 5 hours. Delayed graft function has been reported in 12% of transplants and one transplant has been reported to have failed.

Conclusions A protocol for domino (chain) paired donation has been agreed whereby altruistic non-directed donors will donate to the paired donation list rather than donating directly to the deceased donor (DD) list as currently. It was agreed, however, that if a high priority match was identified on the DD list, then the altruistic donor kidney would still be allocated directly to that patient. In 2009 paired donor transplants represented 3.1% of living donor kidney transplants in the UK while altruistic donor transplants represented 1.7%. It is expected that by linking the two programmes the contribution in future years will further increase.

Disclosure: All authors have declared no conflicts of interest.