National Kidney Registry

Last updated

National Kidney Registry
Type Nonprofit
Industry
FoundedJuly 12, 2007;16 years ago (2007-07-12)
Headquarters,
U.S.
Area served
U.S.
Website kidneyregistry.org

The National Kidney Registry (NKR) is a national registry in the United States listing kidney donors and recipients in need of a kidney transplant. NKR facilitates over 450 "Kidney Paired Donation" (KPD) or "Paired Exchange" transplants annually. [1] [2]

Contents

More than one-third of potential living kidney donors who want to donate their kidney to a friend or family member cannot because of blood type or antibody incompatibility. [3] Historically, these donors would be turned away and the patient would lose the opportunity to receive a life-saving kidney transplant. KPD overcomes donor-recipient incompatibility by swapping kidneys between multiple donor-recipient pairs, and connecting them in longer chains, as well as taking an altruistic non-directed donor, and start chains of kidney transplants.

What the NKR does is consolidate the incompatible pairs of donors and recipients from transplant centers all over the United States, into a single registry, and facilitate the transplant process.

History

The NKR was founded in 2007 by the Hil family, after their youngest daughter lost her kidney function at age ten. Both parents were ruled out from donating to their daughter because they were biologically incompatible. After many unsuccessful attempts to find a compatible donor through all of the kidney paired exchange programs in the United States, a compatible donor was found. After this transplant ordeal, the Hil family founded the National Kidney Registry to eliminate the problem of incompatible donors, by building a national kidney paired donation (KPD) program. [4]

The NKR organized its first swap on Valentine's Day in 2008 at Cornell Medical Center in New York City. [5] This first swap was a 3-deep chain that ended with a bridge donor who donated two months later, extending the chain to 5-deep. [6] This chain was broken after the bridge donor reneged following many failed cross matches that required the donor to repeatedly go to the hospital for blood draws.[ citation needed ]

The NKR's second swap started with the shipment of a kidney from Cornell to UCLA School of Medicine. This was the first time a living donor kidney was shipped on a commercial airplane. This second chain crossed the country three times, facilitating eight total transplants at UCLA, Cornell, Stanford University School of Medicine, and California Pacific Medical Center. [7] Ultimately, this chain was broken when the bridge donor reneged.[ citation needed ]

Based on these early experiences, many safeguards were implemented to reduce the risk of broken chains, which dropped the frequency of broken chains from 33% in 2008 to 2% in 2015. [2]

In 2012, the NKR broke the world record for the largest kidney swap by organizing a 30-deep chain involving 60 donors and recipients. This chain was started by Rick Ruzzamenti, a 44-year-old from Riverside, California. The swap took four months to complete and involved 17 different transplant centers across 11 states. [8] Three years later, on March 26, the next record breaking chain was set into motion by Kathy Hart, a 48-year-old attorney from Minneapolis. This swap took two months to complete and involved 26 different transplant centers. [9]

The NKR has facilitated 3214 kidney transplants, as of March 17, 2019. [10]

Key Innovations

The rapid growth of KPD transplants in the United States has been driven by the following key NKR innovations.

Media Coverage

The NKR's innovations have generated significant media coverage including a front-page story in the New York Times . [27] and nationally televised interviews by Katie Couric with the CBS Evening News . [28] Diane Sawyer from ABC News, [29] and Byron Pitts at Nightline . [30]

Related Research Articles

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<span class="mw-page-title-main">Organ transplantation</span> Medical procedure in which an organ is removed from one body and placed in the body of a recipient

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<span class="mw-page-title-main">Kidney transplantation</span> Medical procedure

Kidney transplant or renal transplant is the organ transplant of a kidney into a patient with end-stage kidney disease (ESRD). Kidney transplant is typically classified as deceased-donor or living-donor transplantation depending on the source of the donor organ. Living-donor kidney transplants are further characterized as genetically related (living-related) or non-related (living-unrelated) transplants, depending on whether a biological relationship exists between the donor and recipient.

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Kidney paired donation (KPD), or paired exchange, is an approach to living donor kidney transplantation where patients with incompatible donors swap kidneys to receive a compatible kidney. KPD is used in situations where a potential donor is incompatible. Because better donor HLA and age matching are correlated with lower lifetime mortality and longer lasting kidney transplants, many compatible pairs are also participating in swaps to find better matched kidneys. In the United States, the National Kidney Registry organizes the majority of U.S. KPD transplants, including the largest swaps. The first large swap was a 60 participant chain in 2012 that appeared on the front page of the New York Times and the second, even larger swap, included 70 participants and was completed in 2014. Other KPD programs in the U.S. include the UNOS program, which was launched in 2010 and completed its 100th KPD transplant in 2014, and the Alliance for Paired Donation.

<span class="mw-page-title-main">Dorry Segev</span> American surgeon

Dorry L. Segev is the Marjory K. and Thomas Pozefsky Professor of Surgery at Johns Hopkins School of Medicine, professor of epidemiology at Johns Hopkins Bloomberg School of Public Health, and associate vice chair of the Department of Surgery at Johns Hopkins Hospital. He has made significant contributions to the field of transplantation, including developing a mathematical model to facilitate a nationwide kidney paired donation program, both in the US and Canada. He is also known for his role in getting the HIV Organ Policy Equity Act signed into law.

Donor-specific antibodies (DSA) are a concept in transplantation medicine and describe the presence of antibodies specific to the Donor's HLA-Molecules. These antibodies can cause antibody-mediated rejection and are therefore considered a contraindication against transplantation in most cases. DSA are a result of B cell and plasma cell activation and bind to HLA and/or non-HLA molecules on the endothelium of the graft. They were first described in 1969 by Patel et al., who found that Transplant recipients who were positively tested for DSA using a complement-dependent cytotoxicity crossmatch assay had a higher risk of transplant rejection. DSA can either be pre-formed or can be formed as a response to the transplantion.

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Optimal kidney exchange (OKE) is an optimization problem faced by programs for kidney paired donations (also called Kidney Exchange Programs). Such programs have large databases of patient-donor pairs, where the donor is willing to donate a kidney in order to help the patient, but cannot do so due to medical incompatibility. The centers try to arrange exchanges between such pairs. For example, the donor in pair A donates to the patient in pair B, the donor in pair B donates to the patient in pair C, and the donor in pair C donates to the patient in pair A.

References

  1. Transplant:Donor Relation by Transplant Center (Report). Organ Procurement and Transplantation Network. Retrieved April 6, 2016.
  2. 1 2 3 Paired Exchange Results Quarterly Report (Report). National Kidney Registry. 2015.
  3. Segev; Gentry; Warren; Reeb; Montgomery (April 20, 2005). "Kidney Paired Donation and Optimizing the Use of Live Donor Organs". JAMA. 293 (15): 1883–1890. doi:10.1001/jama.293.15.1883. PMID   15840863.
  4. "Garet Hil".
  5. "First Valentine's Day Donor Chain" (Press release). National Kidney Registry. February 20, 2008.
  6. "Acts of Kindness Between Strangers". NBC New York Nightly. Retrieved April 7, 2016.
  7. Asynchronous, Out-of-Sequence, Transcontinental Chain Kidney Transplantation. American Journal of Transplantation (Report). 2009.
  8. "Largest Kidney Donor Chain: National Kidney Registry sets world record". www.worldrecordacademy.com. World Record Academy. February 21, 2012.
  9. Pitts; Louszko; Cappetta; Effron; Valiente (April 14, 2015). "Donating a Kidney to a Complete Stranger in Order to Save a Loved One". ABC News.
  10. "National Kidney Registry | Facilitating Living Kidney Donation". National Kidney Registry.
  11. Baxter-Lowe; Cecka; Kamoun; Sinacore; Melcher (February 26, 2016). "Center-Defined Unacceptable HLA Antigens Facilitate Transplants for Sensitized Patients in a Multi-Center Kidney Exchange Program". XX. American Journal of Transplantation: 1–7.{{cite journal}}: Cite journal requires |journal= (help)
  12. Veale; Hil. "National Kidney Registry: 213 Transplants in 3 Years". Clinical Transplants 2010: 333–344.{{cite journal}}: Cite journal requires |journal= (help)
  13. Mast; Vaughan; Busque; Veale; Roberts; Straub; Flores; Canari; Levy; Tietjen; Hil; Melcher (June 8, 2011). "Managing Finances of Shipping Living Donor Kidneys for Donor Exchanges". American Journal of Transplantation. 11 (9): 1810–4. doi:10.1111/j.1600-6143.2011.03690.x. PMID   21831153. S2CID   21203899.
  14. "NKR Introduces GPS Tracking Technology" (Press release). National Kidney Registry. August 16, 2010.
  15. Timmer (January 6, 2015). "The math of organ donation:Kidneys are an NP-Hard problem". Ars Technica.
  16. "Medical Board Policies". www.kidneyregistry.org. National Kidney Registry. Retrieved April 10, 2016.
  17. Veale; Hil (April 9, 2012). "The National Kidney Registry:175 Transplants in One Year". Clinical Transplants 2011.{{cite journal}}: Cite journal requires |journal= (help)
  18. "Where Are We Going with Kidney Paired Donation? A Nationally-run Private Program Works Best". American Society of Transplantation.{{cite journal}}: Cite journal requires |journal= (help)
  19. Segev, Dorry L.; Gentry, Sommer E.; Melancon, J. Keith; Montgomery, Robert A. (October 2005). "Characterization of waiting times in a simulation of kidney paired donation". American Journal of Transplantation. 5 (10): 2448–2455. doi: 10.1111/j.1600-6143.2005.01048.x . ISSN   1600-6135. PMID   16162194.
  20. Bingaman; Wright Jr.; Kapturczak; Shen; Vick; Murphey (March 1, 2012). "Single-Center Kidney Paired Donation: The Methodist San Antonio Experience". American Journal of Transplantation. 12 (8): 2125–2132. doi: 10.1111/j.1600-6143.2012.04070.x . PMID   22548839. S2CID   25144900.
  21. 1 2 "National Kidney Registry Initiates Donor Blood Cryo-Preservation" (Press release). National Kidney Registry. December 2, 2014.
  22. Berz; McCormack; Winer; Colvin; Quesenberry (November 12, 2007). "Cryopreservation of Hematopoietic Stem Cells". Am. J. Hematol. 82 (6): 463–472. doi:10.1002/ajh.20707. PMC   2075525 . PMID   17266054.
  23. Flechner; Leeser; Pelletier; Morgievich; Miller; Thompson; McGuire; Sinacore; Hil (March 31, 2015). "The Incorporation of an Advanced Donation Program Into Kidney Paired Exchange: Initial Experience of the National Kidney Registry". XX. American Journal of Transplantation: 1–6.{{cite journal}}: Cite journal requires |journal= (help)
  24. "National Kidney Registry Press Release".
  25. Treat, Eric G.; Miller, Eric T.; Kwan, Lorna; Connor, Sarah E.; Maliski, Sally L.; Hicks, Elisabeth M.; Williams, Kristen C.; Whitted, Lauren A.; Gritsch, Hans A. (November 2014). "Outcomes of shipped live donor kidney transplants compared with traditional living donor kidney transplants". Transplant International. 27 (11): 1175–1182. doi:10.1111/tri.12405. ISSN   1432-2277. PMID   25052215. S2CID   2156607.
  26. Treat, Eric; Chow, Eric K. H.; Peipert, John D.; Waterman, Amy; Kwan, Lorna; Massie, Allan B.; Thomas, Alvin G.; Bowring, Mary Grace; Leeser, David (November 22, 2017). "Shipping living donor kidneys and transplant recipient outcomes". American Journal of Transplantation. 18 (3): 632–641. doi:10.1111/ajt.14597. ISSN   1600-6143. PMC   6354257 . PMID   29165871.
  27. Sack, Kevin (February 18, 2012). "60 Lives, 30 Kidneys, All Linked". New York Times.
  28. Couric, Katie (November 10, 2010). "Kidney Chains Link Strangers". CBS Evening News.
  29. Sawyer, Diane (February 20, 2012). "Kidney Donation Leads to Unexpected Kindness". ABC News.
  30. Pitts; Louszko; Cappetta; Effron; Valiente (April 15, 2015). "Changing Lives Through Donating Kidneys to Strangers". ABC News Nightline.