Altruistic Donor Chains
A non-directed altruistic donor (NDAD) chooses to donate into the paired/pooled donation (PPD) scheme to create a chain of
transplants. The donated kidney is allocated to a recipient in the paired/pooled scheme and, in turn, the donor registered with
that recipient donates to another recipient and so on. The chain ends when the last donor donates to a recipient on the national
All eligible NDADs (i.e. those who have completed donor assessment and have HTA approval) have an opportunity to ‘opt in’ to initiate an altruistic donor chain (ADC) in the next living donor kidney matching run (LDKMR), instead of donating directly to a recipient on the national transplant (deceased donor (DD)) list. When the NDAD donates into the PPD scheme, the donation potentially triggers one or more paired donations, ending the chain with a donation back to the national transplant list. (Figure 1). A ‘short’ ADC includes one PPD pair; a 'long' ADC includes more than one PPD pair.
- High priority patients on the DD list take precedence (approx 8% of altruistic donor kidneys) and all NDAD kidneys are offered to these patients first, even if the NDAD has opted to take part in the quarterly LDKMR. A high priority patient is defined as a patient appearing in Tiers A to C of the DD matching run (including clinically urgent paediatric patients).
- The preferred option for the NDAD is the 'opt in' to maximise the transplant yield but all NDADs have an equal choice to 'opt out' at the point of registration with NHSBT.
- If the ADC falls through, the NDAD can choose to donate directly to the DD list to avoid delay or to choose to wait for the next LDKMR.
- All donor operations in the PPD and ADC schemes will be performed as per arrangements agreed by NHSBT Kidney Advisory Group i.e. simultaneous/same day procedures.
- Special considerations can be specified relating to the donor/kidney to be donated that are relevant to the acceptance of a donated kidney.
Summary of Arrangements for Non-Directed Altruistic Donation (NDAD) with Altruistic Donor Chains (ADC)
Confirmation of inclusion to ODT to be made by named LDC transplant centre contact up to 12 working days prior to the LDKMR for donors with special considerations and up to 5 working days prior to the LDKMR for donors without special considerations.
- Human Tissue Authority (HTA) approval process via local Independent Assessor and HTA panel for paired/pooled donor-recipient pairs.
- Date of surgery scheduled between centres to facilitate simultaneous surgery for all 'pairs' to conform to clinical standard of 8 weeks from notification of matches to scheduling of surgery. Anonymity as for PPD.
- Final crossmatch tests according to agreed protocol prior to scheduled date of surgery.
- Suitable storage and transport of kidneys arranged by named LDC contacts in transplant centres.