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UCSF Transplant Surgeon Dr. Sandy Feng to Lead Consensus Conference on Kidney Paired Donation (KPD)

Sandy Feng, M.D. Ph.D.

 In excess of 90,000 people are on the waiting list for kidney transplants, fewer than 17,000 receive one each year, and about 4,500 die on the waiting list. Even where a relative or friend is willing to donate a kidney, the kidney may not be a biological match. To address this problem, paired kidney exchange programs were created. Although it has been more than a decade since the first paired kidney exchange took place in the U.S., there is still no uniform system for these exchanges.

Sandy Feng, M.D., Ph.D., a transplant surgeon at UCSF, is currently organizing the Consensus Conference on Kidney Paired Donation (KPD) taking place at the end of March. Members of several stakeholder organizations, including the American Society of Transplantation (AST), the American Societies of Transplant Surgeons (ASTS) and Nephrology (ASN), will discuss "pressing issues limiting implementation of KPD and develop a consensus-driven model to overcome barriers. It is anticipated that the output of the workgroups at this conference will provide the basis for practices enabling widespread implementation of KPD in the United States." 

The Conference, will provide a unique opportunity for thought leaders, practitioners, patients, administrators, policy makers, mathematicians, social scientists, ethicists, and regulatory representatives to convene with a common focus to achieve consensus regarding the principles and practice of KPD.

As the organizer of the event, Dr. Feng was cited in the article, Lack of Unified System Hampers Kidney Transplant Efforts (The New York Times) in conjunction with an extensive feature story, 60 Lives, 30 Kidneys, All Linked (The New York Times).

About Kidney Paired Donation (KPD)

In 2010, more than 570,000 individuals in the United States suffer from end stage renal disease (ESRD). Kidney transplantation is widely recognized to be the most effective treatment for ESRD. In spite of continual efforts to increase the number of deceased donor kidneys, need far exceeds supply. Living donor kidney transplantation, whereby the transplant candidate receives a healthy kidney from a healthy living donor, is a highly viable and desirable alternative for many. Unfortunately, although transplant candidates may present with one or more potential living donors, one-third of these potential donations do not lead to a transplant because of blood type or immunologic incompatibility.

Kidney paired donation (KPD) is a unique and powerful approach that can enable donors to indirectly donate to their intended recipient. Two candidates with willing and healthy but incompatible donors can exchange donor grafts such that two compatible transplants can take place. Beyond simple exchanges between two donor/recipient pairs at a single transplant center, computer algorithms can create complex exchanges among multiple incompatible pairs at different transplant centers, tremendously expanding the potential of this innovative approach. In 2007, Congress defined and supported KPD by passing the Charlie Norwood Living Organ Donation Act (public law #110-144).

A Need for Consensus

KPD is clearly the most effective approach to recruit a substantial pool of high quality kidneys from healthy living donors who otherwise would not have donated because of incompatibility with their loved one. However, compared to data-driven projections, KPD remains grossly underutilized. Moreover, the emergence of multiple KPD programs with diverse approaches and processes attests to a lack of consensus as to how to maximize the benefit and minimize the risk of KPD.

Now is clearly the time to shape the evolution and expansion of KPD with the goals of optimizing donor and recipient safety and maximizing programmatic utility and efficiency. Heretofore, KPD has been discussed predominantly by academic innovators at transplant meetings. Comprehensive delineation of the challenges, controversies, and stakeholders in KPD has demonstrated a pressing need to hold a Consensus Conference.

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