DEC-K Programme (DECeased Kidney paired exchange):

Impact: Health impacts

Narrative

The literature on the allocation of indivisible objects in economies without money has found a remarkable application in the design of Kidney Paired Exchange (KPE) programs. These programs try to overcome any incompatibility (of blood or tissue types) of living donor-patient pairs by arranging swaps of donors among
several pairs. Apart from the problem of finding mutually compatible donor-patient pairs, the design of PKE programs needs to address many constraints that are absent in the standard allocation problems. KPE programs usually involve the cooperation and coordination of several transplantation units at different medical centers. Logistic constraints (the use of different operations rooms, surgical teams, and the timing
of the procedures) make exchanges involving too many donor patient-pairs unfeasible. Real-life PKE programs have generally focused on maximizing the number of simultaneous compatible organ exchanges between two donor-patient pairs, although swaps involving more than two pairs are also carried out. To
deal with situations where a donor-patient pair is involved in more than one viable exchange, KPE programs usually rely on giving priority (sequentially) to certain patients in much the same way as in the allocation of kidneys obtained from cadaveric donors. In spite of all their intrinsic difficulties, KPE programs are a remarkable example of how efficiency enhancement exchanges can be generated without any need
for monetary compensations. It is commonly believed, however, that KPE programs could attain even outcomes if it could be possible to expand the number of pairs participating to these programs. Several options to expand KPE have been proposed in the last few years, with dissimilar applicability:
1. A nationwide and international KPE registry and match run.
2. The inclusion of altruistic donors to initiate chains of KPE.
3. The combination of KPE with desensitization to relax the requirement for a negative crossmatch for highly sensitized patients.
4. The inclusion of compatible pairs into single-centre pools.
5 More recently, the utilization of deceased donor kidneys to initiate living donor chains.
The aim of the project was to quantify the potential gain of this proposal and to design an algorithm to implement this program, first at the local level of the Kidney Transplant Unit at the Padova Hospital, and, eventually at the national level.
First we measured the gain of implementing chains of donations starting from a deceased donor, at local level, by means of a retrospective study.
We use data on the pool of donor/recipient incompatible pairs at the Kidney and Pancreas Transplantation Unit of the Padua University-Hospital in the three-year period 2012-2014. Our study shows the great potential of this program because 50% of the incompatible pairs enrolled at the waiting list in Padua and 17% of "unlikely transplantabilty" patients (enrolled in the waiting list for a cadaveric organ because they had not a willing donor) could have been transplanted.
Thanks to this study we proposed to implement the DEC-K program the Director Italian Transplant Centre who enthusiastically supported this initiative. After having received the approval of the Ethical Committee of the Veneto Region and the University a pilot implementation of the program will start in the next months, February-March 2018

Category of impact

  • Health impacts
Date
1 Mar 2018 - 1 Dec 2018

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