Skip to main content
SpringerLink
Log in

Kidney Paired Donation in Developing Countries: a Global Perspective

  • Published:
Current Transplantation Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

We review the key principles of kidney paired donation (KPD) and discuss the status and unique considerations for KPD in developing countries.

Recent Findings

Despite the advantages of KPD programs, they remain rare among developing nations, and the programs that exist have many differences with those of in developed countries. There is a paucity of literature and lack of published data on KPD from most of the developing nations. Expanding KPD programs may require the adoption of features and innovations of successful KPD programs. Cooperation with national and international societies should be encouraged to ensure endorsement and sharing of best practices.

Summary

KPD is in the initial stages or has not yet started in the majority of the emerging nations. But the logistics and strategies required to implement KPD in developing nations differ from other parts of the world. By learning from the KPD experience in developing countries and adapting to their unique needs, it should be possible to expand access to KPD to allow more transplants to happen for patients in need worldwide.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data Availability

Not applicable

References

  1. Global Observatory on Donation and Transplantation. WHO-ONT , 2022. http://www.transplant-observatory.org/

    Google Scholar 

  2. Kute V, Ramesh V, Shroff S, Guleria S, Prakash J. Deceased-donor organ transplantation in india: current status, challenges, and solutions. Exp Clin Transplant. 2020;18(Suppl 2):31–42. https://doi.org/10.6002/ect.rlgnsymp2020.L6.

    Article  PubMed  Google Scholar 

  3. Scurt FG, Ewert L, Mertens PR, Haller H, Schmidt BMW, Chatzikyrkou C. Clinical outcomes after ABO-incompatible renal transplantation: a systematic review and meta-analysis. Lancet. 2019;393(10185):2059–72. https://doi.org/10.1016/S0140-6736(18)32091-9.

    Article  PubMed  Google Scholar 

  4. Held PJ, McCormick F. ABO-incompatible kidney transplants: twice as expensive, half as good. Am J Transplant. 2016;16(5):1343–4. https://doi.org/10.1111/ajt.13638.

    Article  CAS  PubMed  Google Scholar 

  5. Pankhurst L, Hudson A, Mumford L, et al. The UK National Registry of ABO and HLA antibody incompatible renal transplantation: pretransplant factors associated with outcome in 879 transplants. Transplant Direct. 2017;3(7):e181. https://doi.org/10.1097/TXD.0000000000000695.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Rapaport FT. The case for a living emotionally related international kidney donor exchange registry. Transplant Proc. 1986;18((3) Suppl. 2):5–9.

    CAS  PubMed  Google Scholar 

  7. Kwak JY, Kwon OJ, Lee KS, Kang CM, Park HY, Kim JH. Exchange-donor program in renal transplantation: a single-center experience. Transplant Proc. 1999;31(1-2):344–5. https://doi.org/10.1016/s0041-1345(98)01655-8.

    Article  CAS  PubMed  Google Scholar 

  8. Cooper M, Leeser DB, Flechner SM, et al. Ensuring the need is met: a 50-year simulation study of the National Kidney Registry’s family voucher program. Am J Transplant. 2021;21(3):1128–37. https://doi.org/10.1111/ajt.16101.

    Article  PubMed  Google Scholar 

  9. Veale JL, Capron AM, Nassiri N, et al. Vouchers for future kidney transplants to overcome “chronological incompatibility” between living donors and recipients. Transplantation. 2017;101(9):2115–9. https://doi.org/10.1097/TP.0000000000001744.

    Article  PubMed  Google Scholar 

  10. Matas AJ. Nondirected, advanced, and voucher-based donation-the importance of terminology. JAMA Surg. 2022;157(3):280. https://doi.org/10.1001/jamasurg.2021.5767.

    Article  PubMed  Google Scholar 

  11. Feizi M, Moeindarbari T. Characteristics of kidney donors and recipients in Iranian kidney market: evidence from Mashhad. Clin Transplant. 2019;33(10):e13650. https://doi.org/10.1111/ctr.13650.

    Article  PubMed  Google Scholar 

  12. Nizam N, Mazhar F, Abbas K, et al. Kidney swap in Pakistan: experience at the Sindh Institute of Urology and Transplantation. Exp Clin Transplant. 2017;15(Suppl 1):76–8. https://doi.org/10.6002/ect.mesot2016.O63.

    Article  PubMed  Google Scholar 

  13. Kute VB, Patel HV, Shah PR, et al. Impact of single centre kidney paired donation transplantation to increase donor pool in India: a cohort study. Transpl Int. 2017;30(7):679–88. https://doi.org/10.1111/tri.12956.

    Article  PubMed  Google Scholar 

  14. Kute VB, Patel HV, Modi PR, et al. Non-simultaneous kidney exchange cycles in resource-restricted countries without non-directed donation - a prospective single-center cohort study. Transpl Int. 2021;34(4):669–80. https://doi.org/10.1111/tri.13833.

    Article  CAS  PubMed  Google Scholar 

  15. Kute VB, Patel HV, Modi PR, et al. Paired kidney exchange in India: future potential and Challenges based on the experience at a single center. Transplantation. 2021;105(5):929–32. https://doi.org/10.1097/TP.0000000000003421.

    Article  PubMed  Google Scholar 

  16. Ahmad I, Saxena S, Bansal R, et al. First successful three-way kidney exchange transplantation in North India. Indian J Nephrol. 2021;31(2):169–72. https://doi.org/10.4103/ijn.IJN_116_19.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Toews M, Giancaspro M, Richards B, Ferrari P. Kidney paired donation and the “valuable consideration” problem: the experiences of Australia, Canada, and the United States. Transplantation. 2017;101(9):1996–2002. https://doi.org/10.1097/TP.0000000000001778.

    Article  PubMed  Google Scholar 

  18. Liyanage T, Ninomiya T, Jha V, et al. Worldwide access to treatment for end-stage kidney disease: a systematic review. Lancet. 2015;385(9981):1975–82. https://doi.org/10.1016/S0140-6736(14)61601-9.

    Article  PubMed  Google Scholar 

  19. Rees MA, Dunn TB, Kuhr CS, et al. Kidney exchange to overcome financial barriers to kidney transplantation. Am J Transplant. 2017;17(3):782–90. https://doi.org/10.1111/ajt.14106.

    Article  CAS  PubMed  Google Scholar 

  20. Minerva F, Savulescu J, Singer P. The ethics of the global kidney exchange programme. Lancet. 2019;394(10210):1775–8. https://doi.org/10.1016/S0140-6736(19)32474-2.

    Article  PubMed  Google Scholar 

  21. Singer P, Minerva F, Savulescu J. The global kidney exchange programme - authors’ reply. Lancet. 2020;395(10235):1485–6. https://doi.org/10.1016/S0140-6736(20)30619-X.

    Article  PubMed  Google Scholar 

  22. Ambagtsheer F, Haase-Kromwijk B, Dor F, et al. Global kidney exchange: opportunity or exploitation? An ELPAT/ESOT appraisal. Transpl Int. 2020;33(9):989–98. https://doi.org/10.1111/tri.13630.

    Article  PubMed  Google Scholar 

  23. Rees MA, Paloyo SR, Roth AE, et al. Global kidney exchange: financially incompatible pairs are not transplantable compatible pairs. Am J Transplant. 2017;17(10):2743–4. https://doi.org/10.1111/ajt.14451.

    Article  CAS  PubMed  Google Scholar 

  24. Marino IRRA, Rees MA, Doria C. Open dialogue between professionals with different opinions builds the best policy. Am J Transplant. 2017;17(10):2749.

    Article  PubMed  Google Scholar 

  25. Roth AE, Krawiec KD, Paloyo S, et al. People should not be banned from transplantation only because of their country of origin. Am J Transplant. 2017;17(10):2747–8. https://doi.org/10.1111/ajt.14485.

    Article  PubMed  Google Scholar 

  26. Roth AE, Marino IR, Ekwenna O, et al. Global kidney exchange should expand wisely. Transpl Int. 2020;33(9):985–8. https://doi.org/10.1111/tri.13656.

    Article  PubMed  Google Scholar 

  27. Lopez-Fraga M, Dominguez-Gil B. The global kidney exchange programme. Lancet. 2020;395(10235):–1484. https://doi.org/10.1016/S0140-6736(20)30614-0.

  28. Valera LCM. The Global Kidney Exchange programme. Lancet. 2020;395(10235):1484–5.

    Article  PubMed  Google Scholar 

  29. Danovitch GM. The Global Kidney Exchange programme. Lancet. 2020;395(10235):1485. https://doi.org/10.1016/S0140-6736(20)30615-2.

    Article  PubMed  Google Scholar 

  30. Roth AE, Wang SW. Popular repugnance contrasts with legal bans on controversial markets. Proc Natl Acad Sci U S A. 2020;117(33):19792–8. https://doi.org/10.1073/pnas.2005828117.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Baines LS, Jindal RM. Comment: kidney exchange to overcome financial barriers to kidney transplantation. Am J Transplant. 2017;17(10):2742. https://doi.org/10.1111/ajt.14325.

    Article  CAS  PubMed  Google Scholar 

  32. Kute V, Jindal RM, Prasad N. Kidney paired-donation program versus global kidney exchange in India. Am J Transplant. 2017;17(10):2740–1. https://doi.org/10.1111/ajt.14324.

    Article  CAS  PubMed  Google Scholar 

  33. Bozek DN, Dunn TB, Kuhr CS, et al. Complete chain of the first global kidney exchange transplant and 3-yr Follow-up. Eur Urol Focus. 2018;4(2):190–7. https://doi.org/10.1016/j.euf.2018.07.021.

    Article  PubMed  Google Scholar 

  34. Rees M (Personal communication) 20 August  2023.

  35. Stepkowski SM, Mierzejewska B, Fumo D, et al. The 6-year clinical outcomes for patients registered in a multiregional United States kidney paired donation program - a retrospective study. Transpl Int. 2019;32(8):839–53. https://doi.org/10.1111/tri.13423.

    Article  PubMed  Google Scholar 

  36. Hadaya K, Fehr T, Rusi B, Ferrari-Lacraz S, Jean V, Ferrari P. Kidney paired donation: a plea for a Swiss National Programme. Swiss Med Wkly. 2015;145:w14083. https://doi.org/10.4414/smw.2015.14083.

    Article  PubMed  Google Scholar 

  37. Cantwell L, Woodroffe C, Holdsworth R, Ferrari P. Four years of experience with the Australian kidney paired donation programme. Nephrology (Carlton). 2015;20(3):124–31. https://doi.org/10.1111/nep.12369.

    Article  PubMed  Google Scholar 

  38. Cole EH, Nickerson P, Campbell P, et al. The Canadian kidney paired donation program: a national program to increase living donor transplantation. Transplantation. 2015;99(5):985–90. https://doi.org/10.1097/TP.0000000000000455.

    Article  CAS  PubMed  Google Scholar 

  39. Malik S, Cole E. Foundations and principles of the Canadian living donor paired exchange program. Can J Kidney Health Dis. 2014;1:6. https://doi.org/10.1186/2054-3581-1-6.

    Article  PubMed  PubMed Central  Google Scholar 

  40. de Klerk M, Witvliet MD, Haase-Kromwijk BJ, Weimar W, Claas FH. A flexible national living donor kidney exchange program taking advantage of a central histocompatibility laboratory: the Dutch model. Clin Transpl. 2008:69–73. https://terasaki.org/store/CH6-deKlerk. Accessed 9 Aug 2023.

  41. Johnson RJ, Allen JE, Fuggle SV, Bradley JA, Rudge C, Kidney Advisory Group UKTN. Early experience of paired living kidney donation in the United kingdom. Transplantation. 2008;86(12):1672–7. https://doi.org/10.1097/TP.0b013e3181901a3d.

    Article  Google Scholar 

  42. Osbun N, Thomas AG, Ronin M, et al. The benefit to waitlist patients in a national paired kidney exchange program: exploring characteristics of chain end living donor transplants. Am J Transplant. 2022;22(1):113–21. https://doi.org/10.1111/ajt.16749.

    Article  PubMed  Google Scholar 

  43. Mierzejewska B, Durlik M, Lisik W, et al. Current approaches in national kidney paired donation programs. Ann Transplant. 2013;18:112–24. https://doi.org/10.12659/AOT.889096.

    Article  CAS  PubMed  Google Scholar 

  44. Bastos J, Mankowski M, Gentry S, et al. Kidney paired donation in Brazil - a single center perspective. Transpl Int. 2021;34(8):1568–70. https://doi.org/10.1111/tri.13923.

    Article  PubMed  Google Scholar 

  45. Kher V, Jha PK. Paired kidney exchange transplantation - pushing the boundaries. Transpl Int. 2020;33(9):975–84. https://doi.org/10.1111/tri.13693.

    Article  PubMed  Google Scholar 

  46. Chandra Shrestha P, Bhandari TR, Adhikari R, Baral H, Verma RK, Shrestha KK. Living donor kidney paired exchange: an observational study. Ann Med Surg (Lond). 2022;78:103761. https://doi.org/10.1016/j.amsu.2022.103761.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Sahay M. Transplantation of human organs and tissues Act-“Simplified”. Indian J Transplant. 2018;12(2):84.

    Article  Google Scholar 

  48. Lucan M. Five years of single-center experience with paired kidney exchange transplantation. Transplant Proc. 2007;39(5):1371–5. https://doi.org/10.1016/j.transproceed.2007.02.081.

    Article  CAS  PubMed  Google Scholar 

  49. Huh KH, Kim MS, Ju MK, et al. Exchange living-donor kidney transplantation: merits and limitations. Transplantation. 2008;86(3):430–5. https://doi.org/10.1097/TP.0b013e3181804a34.

    Article  PubMed  Google Scholar 

  50. McGregor TB, Sener A, Yetzer K, Gillrie C, Paraskevas S. The impact of COVID-19 on the Canadian kidney paired donation program: an opportunity for universal implementation of kidney shipping. Can J Surg. 2020;63(5):E451–3.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Treat E, Chow EKH, Peipert JD, et al. Shipping living donor kidneys and transplant recipient outcomes. Am J Transplant. 2018;18(3):632–41. https://doi.org/10.1111/ajt.14597.

    Article  PubMed  Google Scholar 

  52. Treat EG, Miller ET, Kwan L, et al. Outcomes of shipped live donor kidney transplants compared with traditional living donor kidney transplants. Transpl Int. 2014;27(11):1175–82. https://doi.org/10.1111/tri.12405.

    Article  PubMed  Google Scholar 

  53. Sickand M, Cuerden MS, Klarenbach SW, et al. Reimbursing live organ donors for incurred non-medical expenses: a global perspective on policies and programs. Am J Transplant. 2009;9(12):2825–36. https://doi.org/10.1111/j.1600-6143.2009.02829.x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Lentine KL, Kasiske BL, Levey AS, et al. KDIGO clinical practice guideline on the evaluation and care of living kidney donors. Transplantation. 2017;101(8S Suppl 1):S1–S109. https://doi.org/10.1097/TP.0000000000001769.

    Article  PubMed  Google Scholar 

  55. Lentine KL, Lam NN, Segev DL. Risks of living kidney donation: current state of knowledge on outcomes important to donors. Clin J Am Soc Nephrol. 2019;14(4):597–608. https://doi.org/10.2215/CJN.11220918.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Wallis CB, Samy KP, Roth AE, Rees MA. Kidney paired donation. Nephrol Dial Transplant. 2011;26(7):2091–9. https://doi.org/10.1093/ndt/gfr155.

    Article  PubMed  Google Scholar 

  57. Ellison B. A Systematic review of kidney paired donation: applying lessons from historic and contemporary case studies to improve the US model. 2014. Wharton Research Scholars Journal. Paper 107. from https://repository.upenn.edu/wharton_research_scholars/107/?utm_source=repository.upenn.edu%2Fwharton_research_scholars%2F107&utm_medium=PDF&utm_campaign=PDFCoverPages or https://www.kidneyregistry.org/wp-content/uploads/2021/03/A-Systematic-Review-of-Kidney-Paired-Donation_-Applying-Lessons-From-Historic-and-Contemporary-Case-Studies-to-Improve-the-US-Model.pdf. Accessed 23 Sept 2022.

  58. The JHU Gazette. Hopkins surgical teams perform historic quintuple kidney swap 2023, Retrieved 11 June, from https://pages.jh.edu/gazette/2006/27nov06/27swap.html

    Google Scholar 

  59. de Klerk M, Keizer KM, Claas FH, Witvliet M, Haase-Kromwijk BJ, Weimar W. The Dutch national living donor kidney exchange program. Am J Transplant. 2005;5(9):2302–5. https://doi.org/10.1111/j.1600-6143.2005.01024.x.

    Article  PubMed  Google Scholar 

  60. Malik S, Cole E, et al. State of the art practices and policies in kidney paired donation. Curr Transpl Rep. 2014;1:10–7. https://doi.org/10.1007/s40472-013-0002-5.

    Article  Google Scholar 

  61. Rees MA, Kopke JE, Pelletier RP, et al. A nonsimultaneous, extended, altruistic-donor chain. N Engl J Med. 2009;360(11):1096–101. https://doi.org/10.1056/NEJMoa0803645.

    Article  CAS  PubMed  Google Scholar 

  62. Congress.gov. H.R.710 - 110th Congress (2007-2008): Charlie W. Norwood Living Organ Donation Act (2007) December 21 Retrieved 11 June, 2023 from https://www.congress.gov/bill/110th-congress/house-bill/710.

  63. Flechner SM, Thomas AG, Ronin M, et al. The first 9 years of kidney paired donation through the National Kidney Registry: characteristics of donors and recipients compared with National Live Donor Transplant Registries. Am J Transplant. 2018;18(11):2730–8. https://doi.org/10.1111/ajt.14744.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Fortin MC, Williams-Jones B. Who should travel in kidney exchange programs: the donor, or the organ? Open Med. 2011;5(1):e23–5.

    PubMed  PubMed Central  Google Scholar 

  65. Johns Hopkins Medicine. Johns Hopkins leads first 16-patient, Multicenter “domino donor” kidney transplant 2023 Retrieved 11 June from https://www.hopkinsmedicine.org/news/media/releases/johns_hopkins_leads_first_16_patient_multicenter_domino_donor_kidney_transplant.

    Google Scholar 

  66. New York Times. 60 lives, 30 kidneys, all linked. In: New York Times; 2023. Retrieved 11 June, from https://www.nytimes.com/2012/02/19/health/lives-forever-linked-through-kidney-transplant-chain-124.html.

    Google Scholar 

  67. ABC News. Donating a kidney to a complete stranger in order to save a loved one 2023 Retrieved 11 June, from https://abcnews.go.com/Health/donating-kidney-complete-stranger-order-save-loved/story?id=30288400.

    Google Scholar 

  68. Biro P, Haase-Kromwijk B, Andersson T, et al. Building kidney exchange programmes in Europe-an overview of exchange practice and activities. Transplantation. 2019;103(7):1514–22. https://doi.org/10.1097/TP.0000000000002432.

    Article  PubMed  PubMed Central  Google Scholar 

  69. European Cooperation in Science and Technology. European Network for Collaboration on Kidney Exchange Programmes (ENCKEP) 2023 Retreived 11 June, from https://www.enckep-cost.eu/

    Google Scholar 

  70. Bingaman AW, Wright FH Jr, Kapturczak M, Shen L, Vick S, Murphey CL. Single-center kidney paired donation: the Methodist San Antonio experience. Am J Transplant. 2012;12(8):2125–32. https://doi.org/10.1111/j.1600-6143.2012.04070.x.

    Article  CAS  PubMed  Google Scholar 

  71. Jan MY, Yaqub MS, Adebiyi OO, et al. Nondirected living kidney donation and recipient outcomes in the United States: a 20-year review. Kidney Int Rep. 2022;7(6):1289–305. https://doi.org/10.1016/j.ekir.2022.03.012.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Leeser DB, Thomas AG, Shaffer AA, et al. Patient and kidney allograft survival with national kidney paired donation. Clin J Am Soc Nephrol. 2020;15(2):228–37. https://doi.org/10.2215/cjn.06660619.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Nephrology and Transplantation, Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences, Ahmedabad, India

    Vivek B. Kute, Sanshriti Chauhan & Hari Shankar Meshram

  2. SSM Health Saint Louis University Hospital Transplant Center, Saint Louis University School of Medicine, Saint Louis, MO, USA

    Vidya A. Fleetwood, Yasar Caliskan, Chintalapati Varma & Krista L. Lentine

  3. Division of Nephrology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey

    Halil Yazıcı & Özgür Akın Oto

  4. Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA

    Krista L. Lentine

Authors
  1. Vivek B. Kute
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vidya A. Fleetwood
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sanshriti Chauhan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hari Shankar Meshram
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yasar Caliskan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Chintalapati Varma
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Halil Yazıcı
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Özgür Akın Oto
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Krista L. Lentine
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors have made equal contributions.

Corresponding author

Correspondence to Vivek B. Kute.

Ethics declarations

Conflict of Interest

KLL is a Senior Scientist of the SRTR, receives research funding related to living donation from the National Institutes of Health (NIH R01DK120551), and is also supported by the Mid-America Transplant/Jane A. Beckman Endowed Chair in Transplantation. KLL is chair of the AST LDCOP, member of the ASN Policy and Advocacy Committee, and a member of the National Kidney Foundation Transplant Advisory Committee. Unrelated to this work, KLL receives consulting fees from CareDx and speaker honoraria from Sanofi.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human and animal subjects performed by any of the authors. No informed consent was required as no individual patient level data was used.

Ethical Approval

We abided with the rules and regulation declaration of Helsinki and Istanbul. No institutional or any other ethical board approval was required as the data presented is retrospective, publicly available from the website.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Vivek B. Kute and Vidya A. Fleetwood are co-first authors.

Krista L. Lentine is the senior author.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kute, V.B., Fleetwood, V.A., Chauhan, S. et al. Kidney Paired Donation in Developing Countries: a Global Perspective. Curr Transpl Rep 10, 117–125 (2023). https://doi.org/10.1007/s40472-023-00401-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40472-023-00401-9

Keywords

Search

Navigation