Increasing transplantability in Brazil: time to discuss Kidney Paired Donation

Introduction: Kidney transplantation (KT) is the best treatment for chronic kidney disease. In Brazil, there are currently more than 26 thousand patients on the waitlist. Kidney Paired Donation (KPD) offers an incompatible donor-recipient pair the possibility to exchange with another pair in the same situation, it is a strategy to raise the number of KT. Discussion: KPD ceased being merely an idea over 20 years ago. It currently accounts for 16.2% of living donors KT (LDKT) in the USA and 8% in Europe. The results are similar to other LDKT. It is a promising alternative especially for highly sensitized recipients, who tend to accumulate on the waitlist. KPD is not limited to developed countries, as excellent results were already published in India in 2014. In Guatemala, the first LDKT through KPD was performed in 2011. However, the practice remains limited to isolated cases in Latin America. Conclusion: KPD programs with different dimensions, acceptance rules and allocation criteria are being developed and expanded worldwide to meet the demands of patients. The rise in transplantability brought about by KPD mostly meets the needs of highly sensitized patients. The Brazilian transplant program is mature enough to accept the challenge of starting its KPD program, intended primarily to benefit patients who have a low probability of receiving a transplant from a deceased donor.

Understanding Patients’ and Living Donors’ Kidney Paired Donation Educational Experiences and Recommendations for Improvement

Introduction Educating potential kidney patients and living donors about the risks and benefits of kidney paired donation to ensure they make informed decisions is complex. This study aimed to increase understanding of patients’ and donors’ decision-making about donation, the educational content they received, and their recommendations for educational improvements. Method We conducted a mixed methods study, including semistructured interviews and quantitative surveys, with 43 participants (25 living donors; 18 kidney recipients). Findings Participants reported that the benefits of paired donation motivated them to participate (ie, helping multiple people, receiving a transplant sooner, flexible timing of donation). Although deciding to participate in paired donation was a systematic, logical, and carefully considered process for some. For most, it was a quickly made, often emotion-based decision. Paired donation educational content on different topics varied, with recipients reporting receiving less information than donors about donor protections and processes to ameliorate the challenges faced, such as broken swaps and chains, and delays in matching. Those who faced challenges requested more information about donor protections and support during and after paired donation. Although many acknowledged their transplant coordinators’ helpfulness, participants also recommended being more proactive in learning about kidney paired donation and speaking to former donors and recipients beforehand. Discussion Standardized, health literate educational content addressing the gaps and variability in education received may help increase paired donation informed decision-making.

The Psychosocial Adjustment of Kidney Recipients in Canada's Kidney Paired Donation Program

Introduction: Kidney paired donation programs have been implemented globally. The involvement of at least 2 donors in these programs might exacerbate recipients’ debt of gratitude and guilt, worries about the donor's health, and worries about graft failure documented by previous studies. However, there is an absence of research on the psychosocial implications of kidney paired donation. This study aimed to provide an in-depth examination of recipients’ experience of kidney paired donation, with a focus on psychosocial adjustment. Methods/Approach: Individual interviews were conducted with 8 recipients who received a transplant through Canada's Kidney Paired Donation program. Data was analyzed using Interpretative Phenomenological Analysis. Findings: Four themes emerged: (a) an emotionally charged relationship with the known donor, (b) optimal distance regulation in the relationship with the anonymous donor, (c) kidney paired donation as a series of ups and downs, and (d) multilayered gratitude. Discussion: Findings are considered in relation to extant literature. Issues relevant to the transplant community's clinical and research efforts to provide kidney recipients responsive care are discussed.

New Perspectives on Desensitization in the Current Era - An Overview

Blood group and tissue incompatibilities remain significant barriers to achieving transplantation. Although no patient should be labeled “un-transplantable” due to blood group or tissue incompatibility, all candidates should be provided with individualized and realistic counseling regarding their anticipated wait times for deceased donor or kidney paired donation matching, with early referral to expert centers for desensitization when needed. Vital is the careful selection of patients whose health status is such that desensitizing treatment is less likely to cause serious harm and whose anti-HLA antibody status is such that treatment is likely to accomplish the goal of increasing organ offers with an acceptable final crossmatch. Exciting new developments have re-energized the interest and scope of desensitization in the times ahead.

The Endgame

This chapter begins with detailing the author's final results following her three-day grueling tests for glucose tolerance, psychological screening, kidney function, EKG, and a chest X-ray. The author found out that there was an issue with her blood pressure. It then outlines the four available choices she could take: to end the process, to lose some weight and reduce salt intake and retest in a few months, to start on a very low dose of antihypertensive medication and retest in two weeks, and finally, to take her current results to the Transplant Selection Committee and hope for the best. Ultimately, the chapter presents an alternative plan, to become part of the Kidney Paired Donation program, if the new blood tests ruled the author unable to donate directly to the intended recipient.

The Odyssey Continues

This chapter chronicles the author's narrative following her new hypertension medication routine until her blood pressure met Mayo standards. It details the costs, the hassles, and the barriers to donating a kidney that the author experienced, notably the blood kit shipping glitch, the early arrival of the blood pressure cuff, and having to return the blood pressure apparatus and submit her PAP smear, colonoscopy, and mammogram results. The chapter then shifts to illustrate the results of the committee deliberation after the rigorous process and evaluation the author went through. Finally, the chapter presents the possibility of entering the Kidney Paired Donation program after the author and Deb Porter Gill obtained the results.

Binary Particle Swarm Optimization Algorithm for Kidney Exchanges Acceleration using Parallel MATLAB

In this paper, we implement a new method binary Particle Swarm Optimization (PSO) for solving the kidney exchange problem, which will improve the future decisions of kidney exchange programs. Because using a kidney exchange, we can help incompatible patient-donor couples to swap donors to receive a compatible kidney. Kidney paired donation programs provide an innovative approach for increasing the number of available kidneys. Further, we implementing binary particle swarm optimization in parallel with MATLAB with one, two, three and four threads and from the computations point of view, the authors compare the performance to reduce the running time for kidney exchange to match patients as fast as possible to help clinicians. Moreover, implementing binary particle swarm optimization in solving the kidney exchange problem is an effective method. The obtained results indicate that binary PSO outperforms other stochastic-based methods such as genetic algorithm, ant lion optimization, and efficient the number of resulting exchanges.