Donor-recipient pairs who are incompatible by Human Lymphocyte Antigen (HLA) type or ABO blood group and unable to donate directly,
one to the other, are registered in a national scheme to achieve compatible transplants with other pairs. When two pairs are involved
it is called 'paired' donation; more than two pairs is called 'pooled' donation. (Figure 1). Compatible donor-recipient pairs who seek
a better HLA or age match may also be registered in the scheme.
Living Donor Kidney Matching Runs (LDKMR) are performed 4 times per year, in January, April, July and October. All donors and recipients who are registered in the NLDKSS and entered into the LDKMR are eligible for inclusion. Each LDKMR identifies paired/pooled exchanges and altruistic donor chains in optimal combinations (see LDKMR matching process), which are reported to transplant centres on the matching run report. To increase the potential of the PPD scheme, the following improvements were introduced in January 2012:
Amended prioritisation criteria including:
- No priority for local exchanges
- No restriction on the allocation of blood group 'O' kidneys
- Incremental prioritisation for recipients who remain unmatched in the scheme after each LDKMR
- Compatible donor-recipient pairs are eligible for the scheme
- Extended matching criteria form for registering patients with low titre HLA and ABO blood group antibodies
- Specification of special considerations relating to the donor +/- kidney to be donated that are relevant to the acceptance of a donated kidney
- A confirmation of inclusion report to ensure that specific criteria have been met by the transplant centre prior to including each donor-recipient pair in the LDKMR
Summary of Arrangements for Paired/Pooled Donation (PPD)
- Human Tissue Authority (HTA) approval process via local Independent Assessor and HTA panel.
- 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.
- 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.
- Anonymity of pairs respected throughout unless all parties wish to break it via the LDCs after surgery.
- Date of transplant confirmed to ODT post surgery by named LDC contacts
- Re-activation on national transplant list by ODT and local leads.
- Registration for PPD 'carried over' pending confirmation of inclusion for next LDKMR.