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Two kidneys changed planes in Pittsburgh. What sounds like the beginning of joke is actually a “landmark in the field of living donor transplantation,” says Surendra Shenoy, MD, director of living donor transplant at Barnes-Jewish Hospital. 

The kidneys’ layover in Pittsburgh on Dec. 6, 2010, was part of the first paired kidney exchange (PKE) transplant in a program piloted by the United Network for Organ Sharing (UNOS), the agency that oversees organ transplantation in the United States. The dual transplants were to take place at Barnes-Jewish Hospital and Dartmouth-Hitchcock Medical Center in Lebanon, NH. 

“Paired kidney exchange programs have allowed for a significant increase in the number of patients that receive a living kidney transplant, therefore freeing up additional deceased donor kidneys for the 80,000 plus people on the national wait list,” says Jason Wellen, MD, surgical director of the Washington University and Barnes-Jewish kidney and kidney/pancreas transplant program. “A nationally run paired exchange program will allow for many new donor/recipient matches to take place that would otherwise not have been available through smaller-run paired exchange programs.”

The pilot program will determine the feasibility of establishing a national registry of candidates for kidney transplant who have a willing but non-matching living donor, similar to the current national list of patients waiting for deceased donors. The list would be checked periodically to see if members of the unmatched donorrecipient pairs match any other potential donors or recipients on the list. Matching pairs could then “swap” donors. 

Both Barnes-Jewish operations and the surgeries at Dartmouth Hitchcock were successful in the exchange, with the transplanted kidneys working as soon as they were implanted. 

PKE transplant has been performed in the United States on a relatively small scale for several years. Barnes-Jewish first took part in a PKE transplant on Feb. 14, 2009, when eight patients at three transplant centers were involved in the swap. But as more than 80,000 Americans wait for donor kidneys, more transplant centers across the country have been looking at PKE as a way to shorten the wait for transplant. 

If the UNOS pilot experience is as positive as the Barnes-Jewish PKE experience has been, a national registry of non-matching pairs and altruistic living donors may be established, Wellen says, ultimately leading to a significant number of transplants. 

“It’s been estimated that a national paired kidney exchange program could result in about 3,000 more transplants each year,” Wellen says. “It has the potential to get a lot of people off of the transplant waiting list.”
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