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Living Donor Options: Paired Kidney Exchange

Living Donor Options: Paired Kidney Exchange. Karen M. Miller, RN, BSN, CCTC October 8, 2011. I have no conflict of interest nor will I be discussing any off-label use of drugs or products. Many paired kidney exchanges to choose from. New England Program for Kidney Exchange (NEPKE)

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Living Donor Options: Paired Kidney Exchange

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  1. Living Donor Options: Paired Kidney Exchange Karen M. Miller, RN, BSN, CCTC October 8, 2011

  2. I have no conflict of interest nor will I be discussing any off-label use of drugs or products

  3. Many paired kidney exchanges to choose from • New England Program for Kidney Exchange (NEPKE) • Hopkins group • Alliance for Paired Kidney Exchange • UNOS • University of Michigan Paired Kidney • North Central Donor Exchange Cooperative • MatchingDonors

  4. National Kidney Registry • Founder, wife and family (six initial donors) were incompatible with daughter • Entered every paired exchange in the United States • No matches found in paired exchange • There had to be a better solution…

  5. Its Success • 501 Non profit corporation • Started with $2,500,000 in contributions • First transplants were facilitated in 2/08 • Over 40 donor chains have been started to date • 349 transplants have been facilitated to date • 10 Month Average Wait Time for Match/Xplant • More swaps than any organization in the world

  6. Evolution of Paired Exchange Non Directed Altruistic Donor Two Pair Exchange R D D Cluster #1 D R R R D R D Three Pair Exchange R Cluster #2 D D D D R R R R D R D R Cluster #3 D Etc.

  7. How Has NKR Been Able To Facilitate So Many Paired Exchange Transplants? • Daily Match Runs Faster matching • Real-time 12 deep matching engine… Modeled after NYSE • Web portal for easy pair enrollment … Fast center startup • No personal information required … Avoids HIPAA issues • Automated match offer & tracking… Organized & efficient • Majority of top centers participating… For the greater good • Not controlled by a single center… No conflict of interest • Leveraging the power of donor chains…Open & closed clusters

  8. Match Offer Process

  9. Speed to MatchEstimates based on blood type combinations & recipient PRA

  10. Participating Center Fee Schedule • Center start-up & training $4,950/ one-time • Additional cost for non-standard NKR BAA $1,000/ one-time • Database management & technology support • 0 transplants facilitated over prior 12 months $100/ month • 1 transplant facilitated over prior 12 months $250/ month • 2 transplants facilitated over prior 12 months $500/ month • 3 transplants facilitated over prior 12 months $750/ month • Additional transplants facilitated prior 12 months $250/ xplant/month • Center annual membership $2,500/ year • Terms • No contract required • Service can be cancelled at any time without penalty

  11. Match Offer Email

  12. Match Offer Medical Information

  13. Match Offer Contacts

  14. UW Experience • Joined NKR 12/1/10 • Have completed 11 transplants, to date, successfully • Have completed 7 non directed donors (humanitarian) • 1st pair entered 12/6/10 • 16 link chain • 16 donors and 16 recipients • 1st pair completed 2/10/11 • UW donor in the OR at 3 am. • UW recipient in the OR at 2pm. • UW donor kidney to UCSF • UW recipient kidney from Pittsburgh • UW donor and recipient (creat 1.4) doing well

  15. The Process

  16. In Summary • National Kidney Registry has completed the most paired kidney transplants compared to any other paired exchange program • Excellent support • Fast paced/high energy • Have assisted UW in completing 11 more transplants. Eleven patients transplanted that, may, otherwise not have received. Two of those patients highly sensitized. • Have assisted UW in started 7 chains (with non directed donors), which has cumulated in 27, additional, transplants throughout the United States

  17. But, it takes a team to make it successful… • Tony D’Alessandro • Luis Fernandez • John Pirsch • Aji Djamali • Transplant surgeons and fellows • Chris Lillesand • Sara O’Loughlin • Elaine Synder and B4/6 staff • HLA staff especially Dave Lorentzen and Katie Meuer • OPO staff especially Mike Anderson • OR team especially Jeff Fenne and Tom Coughlin • Mike Armbrust • Jan Pankow • Kris Patterson • Billing and Fiscal, especially Mary Beth Benson • Data staff, especially Bridget Welch • Transplant Coordinators • Erinn Pullen • Rebecca Hays

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