Rees etal NEJM 2009

Rees etal NEJM 2009 - The n e w e ng l a n d j o u r na l...

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brief report The new england journal of medicine n engl j med 360;11 nejm.org march 12, 2009 1096 A Nonsimultaneous, Extended, Altruistic-Donor Chain Michael A. Rees, M.D., Ph.D., Jonathan E. Kopke, B.S., Ronald P. Pelletier, M.D., Dorry L. Segev, M.D., Matthew E. Rutter, M.D., Alfredo J. Fabrega, M.D., Jeffrey Rogers, M.D., Oleh G. Pankewycz, M.D., Janet Hiller, M.S.N., Alvin E. Roth, Ph.D., Tuomas Sandholm, Ph.D., M. Utku Ünver, Ph.D., and Robert A. Montgomery, M.D., D.Phil. From the Department of Urology, Uni- versity of Toledo Medical Center, Toledo, OH (M.A.R., M.E.R.); the Alliance for Paired Donation, Maumee, OH (M.A.R., R.P.P., M.E.R., J.R., O.G.P.); the Depart- ment of Public Health Sciences, Univer- sity of Cincinnati, Cincinnati (J.E.K.); the Department of General Surgery, Ohio State University, Columbus (R.P.P.); the Depart- ment of Surgery, Johns Hopkins Universi- ty School of Medicine, Baltimore (D.L.S., J.H., R.A.M.); Banner Good Samaritan Transplant Services, Phoenix, AZ (A.J.F.); the Department of General Surgery, Transplantation Services, Wake Forest University Baptist Medical Center, Win- ston-Salem, NC (J.R.); the Department of Surgery, University at Buffalo, State Uni- versity of New York, Buffalo (O.G.P.); the Department of Economics, Harvard Uni- versity, Cambridge, MA, and Harvard Busi- ness School, Boston (A.E.R.); the Com- puter Science Department, Carnegie Mellon University, Pittsburgh (T.S.); and the Department of Economics, Boston College, Chestnut Hill, MA (M.U.Ü.). Ad- dress reprint requests to Dr. Rees at the Department of Urology, University of Toledo Medical Center, Mail Stop 1091, 3000 Arlington Ave., Toledo, OH 43614, or at michael.rees2@utoledo.edu. N Engl J Med 2009;360:1096-101. Copyright © 2009 Massachusetts Medical Society. SUMMARY We report a chain of 10 kidney transplantations, initiated in July 2007 by a single altruistic donor (i.e., a donor without a designated recipient) and coordinated over a period of 8 months by two large paired-donation registries. These transplanta- tions involved six transplantation centers in five states. In the case of five of the transplantations, the donors and their coregistered recipients underwent surgery simultaneously. In the other five cases, “bridge donors” continued the chain as many as 5 months after the coregistered recipients in their own pairs had received transplants. This report of a chain of paired kidney donations, in which the trans- plantations were not necessarily performed simultaneously, illustrates the potential of this strategy. P aired kidney donation is an ev olving strategy for overcoming the barriers that confront patients with end-stage renal disease when the only living potential donors who are willing to donate to them are deemed to be unsuitable as donors for them owing to an incompatibility of blood type, of HLA crossmatch, or of both. In the most basic form of paired donation, the incompati- bility problems with two donor–recipient pairs can be solved by exchanging donors. 1-3 Using advanced software, several organizations have arranged paired kidney donations involving three or more pairs. 4,5 Recent reports describe simulta-
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Rees etal NEJM 2009 - The n e w e ng l a n d j o u r na l...

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