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ORIGINAL ARTICLE
Year : 2018  |  Volume : 12  |  Issue : 3  |  Page : 187-192

A novel method to increase the kidney donor pool: A fusion model linking the deceased donor waitlist to a paired kidney exchange program


1 Department of Nephrology, Bombay Hospital; Apex Swap Transplant Registry-Apex Kidney Foundation, Mumbai, Maharashtra, India
2 Department of Industrial Engineering and Operations Research, IIT Bombay, Mumbai, Maharashtra, India
3 Department of Nephrology, Sushrut Hospital, Mumbai, Maharashtra, India
4 Apex Swap Transplant Registry-Apex Kidney Foundation, Mumbai, Maharashtra, India
5 Department of Nephrology, PD Hinduja Hospital, Mumbai, Maharashtra, India
6 Department of Nephrology, Dr. L.H. Hiranandani Hospital, Mumbai, Maharashtra, India
7 Department of Nephrology, Bombay Hospital, Mumbai, Maharashtra, India

Correspondence Address:
Dr. Viswanath Billa
301, Pearl Belezza, 19th Road, Chembur East, Mumbai - 400 088, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijot.ijot_44_18

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Aim: To merge the deceased donor (DD) and the paired kidney exchange (PKE) allocation processes, creating a fusion model. Materials and Methods: One of the DD kidneys are allocated to the first patient on the DD wait-list and the other kidney is allocated to the PKE registry to initiate a chain of swap transplants. The last donor of this PKE chain donates his kidney back to the second patient on the DD wait-list. Results: There was a 28.1% (P < 0.05) increase in the total number of transplants in the fusion model as compared to the standalone DD and PKE allocation. The mean gain ranges from 8.29 to 19.3 (P < 0.05) across various allocation groups for the O recipients, which is disadvantaged in the standalone PKE registry. Similarly, the mean gain ranges from 5.8 to 18.1 (P < 0.05) across various allocation groups for the AB recipients, which is disadvantaged in the standalone DD registry Furthermore, no blood group type is worse off in terms of the opportunity to receive a kidney by the fusion model. Conclusions: The fusion model can potentially increase the number of transplants that can be performed whenever a DD become available. Despite fairness considerations for patients and their living donors participating in the fusion model, this process increases the opportunity to receive a kidney as well as reduces transplant waiting time in both the registries. This would translate into a survival advantage for the patients.


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