Paired Kidney Exchange

Reviewed by: HU Medical Review Board | Last reviewed: January 2023

Every 10 minutes, someone is added to the transplant waiting list in the United States. With more than 90,000 people waiting for a kidney transplant, it may take that person 3 to 5 years to receive a kidney from a deceased donor.1,2

People in need of a kidney transplant also have the option of a live donor donation. A live donor must be a "match" for the recipient, meaning that certain aspects of their biology must be compatible. Live donor donations usually come from family members.1,2

Family members may be the best match, but this is not always the case. About one-third of all willing live donors are not a match with their recipients. In these cases, a paired kidney exchange may be an option.1,2

What is a paired kidney exchange?

A paired kidney exchange (PKE) is the swapping of kidneys between 2 or more pairs of living donors and recipients. If the living donor in each pair is a match to the recipient in each pair, then the kidneys can be swapped between the two pairs.1,2

The first PKE was performed over 30 years ago as a solution for donors and recipients who did not match. It can now help people find better matches. Finding the best match when you need a kidney transplant could mean that you have to take fewer drugs that lower your immune system. It could also mean that you get a kidney that will last longer.3-5

Other benefits of a PKE may include:4

  • Better graft outcome
  • Lower risk of infection
  • Cost savings

How does a PKE work?

PKEs are arranged through transplant centers. They can be done with multiple pairs of living donors and recipients. Once the pairs are identified, the transplants take place at the same time. This allows recipients to each receive a kidney from a person who is a match. Each living donor gives their kidney to the other living donor’s intended recipient.5

Donors and recipients may also be part of chains. Chains are when there are more than two donors and two recipients. Being a part of a chain allows for more people to receive a living donor transplant. Transplants within a chain may or may not occur on the same day.5

How common are PKEs?

The number of PKEs performed is growing. This type of transplant increases the options for those who are not able to find their own match. In 2021, there were 1,110 PKEs. This makes up about 18.6 percent of living donor kidney transplants.6

Not all transplant centers participate in PKE programs. You will need to research which transplant centers provide it.3

The Kidney Paired Donation Pilot Project

PKE programs such as the Kidney Paired Donation (KPD) Pilot Project are helping to fill the need for more people to receive a donated kidney. The Organ Procurement and Transplantation Network (OPTN) coordinates the KPD Pilot Project. Their vision is that every kidney transplant candidate can receive a kidney.3

The process involves the following steps:3

  • People in need of a kidney transplant register with the KPD Pilot Project.
  • OPTN registers and tracks those who sign up.
  • The donor's and recipient’s medical information is added to the United Network for Organ Sharing (UNOS) system.
  • UNOS works with transplant centers to identify cases where a donor matches the recipient in another pair.

For more information on the KPD Pilot Project, visit the UNOS website. There, you can find:

  • A list of participating transplant centers
  • Current news on PKEs
  • Success stories of people who have had a PKE

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