Transcript Living Donor Options: Paired Kidney Exchange - wi

Living Donor Options:
Paired Kidney Exchange
Karen M. Miller, RN, BSN, CCTC
October 8, 2011
 I have no conflict of interest nor will I
be discussing any off-label use of
drugs or products
Many paired kidney exchanges to
choose from
 New England Program for Kidney
Exchange (NEPKE)
 Hopkins group
 Alliance for Paired Kidney Exchange
 UNOS
 University of Michigan Paired Kidney
 North Central Donor Exchange
Cooperative
 MatchingDonors
National Kidney Registry
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Founder, wife and family (six initial
donors) were incompatible with daughter
Entered every paired exchange in the
United States
No matches found in paired exchange
There had to be a better solution…
Its Success
501 Non profit corporation
Started with $2,500,000 in contributions
First transplants were facilitated in 2/08
Over 40 donor chains have been started to
date
349 transplants have been facilitated to
date
10 Month Average Wait Time for
Match/Xplant
More swaps than any organization in the
world
Evolution of Paired Exchange
Non Directed
Altruistic Donor
Two Pair Exchange
D
D
R
R
Cluster
#1
Three Pair Exchange
R
D
R
R
D
D
R
Cluster
#2
D
D
D
R
D
R
R
R
D
R
R
D
D
Etc.
Cluster
#3
How Has NKR Been Able To Facilitate So Many
Paired Exchange Transplants?
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Daily Match Runs
Faster matching
Real-time 12 deep matching engine… Modeled after NYSE
Web portal for easy pair enrollment … Fast center startup
No personal information required … Avoids HIPAA issues
Automated match offer & tracking… Organized & efficient
Majority of top centers participating…For the greater good
Not controlled by a single center… No conflict of interest
Leveraging the power of donor chains…Open & closed
clusters
Match Offer Process
Daily
Match
Runs
Match
Match
Acceptance
Emailed
Match
Offers
Emailed
1 - 2 Days
Test
Transplant
Cross
Matches
Completed
Cross
Matches
Initiated
10 Days
Surgery
Date/Time
Set
Surgeries
Performed
2-5 Weeks
Speed to Match
Estimates based on blood type
combinations & recipient PRA
Recipient
Direct Donor
Blood Type
Blood Type
< 50%
50%-95%
> 95%
O
1 - 2 weeks
1 - 4 weeks
1 - 6 weeks
AB
B
1 - 3 weeks
1 - 6 weeks
unknown
- Easiest -
A
1 - 4 weeks
1 - 8 weeks
unknown
AB
unknown
unknown
unknown
O
1 - 2 weeks
1 - 4 weeks
1 - 6 weeks
B
1 - 3 weeks
1 - 6 weeks
unknown
A
1 - 4 weeks
1 - 8 weeks
unknown
AB
unknown
unknown
unknown
O
1 - 4 weeks
1 - 8 weeks
1 - 12 weeks
B
1 - 6 weeks
1 - 12 weeks
unknown
A
1 - 8 weeks
1 - 16 weeks
unknown
AB
unknown
unknown
unknown
O
1 - 8 weeks
1 - 16 weeks
unknown
O
B
unknown
unknown
unknown
- Hardest -
A
unknown
unknown
unknown
AB
unknown
unknown
unknown
A
B
Recipient PRA Score
Participating Center Fee Schedule
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Center start-up & training
$4,950/ one-time
Additional cost for non-standard NKR BAA
one-time
Database management & technology support
0 transplants facilitated over prior 12 months
1 transplant facilitated over prior 12 months
2 transplants facilitated over prior 12 months
3 transplants facilitated over prior 12 months
Additional transplants facilitated prior 12 months
xplant/month
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Center annual membership
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Terms
–
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$1,000/
No contract required
Service can be cancelled at any time without penalty
$100/ month
$250/ month
$500/ month
$750/ month
$250/
$2,500/ year
Match Offer Email
Match Offer Medical
Information
NKR Member or One Way Detail
Member or One Way: NKR PASQJ donating to Stanford SUR2040
Dnr Center
Dnr Alias
Recip Center
Recip Alias
One-Way
NKR
PASQJ
Stanford
SUR2040
Center
Alias
ABO
Age
HLA A1
R-Age
D-R Age Delta
0
O
O
63
47
16
R TII
Traveling Dnr?
100.00%
Ship
HLA Bw1
HLA Bw2
Antgn Pts
D-BT
R-BT
D-Age
HLA A2
HLA B1
HLA B2
HLA DR1
HLA DR2
HLA Cw1
Click to return to Center List
HLA Cw2
HLA DQ1
Click to return to Cluster
HLA DQ2
HLA DP1
HLA DP2
HLA DR-51
HLA DR-52
HLA DR-53
Donor
NKR
PASQJ
O
63
HtCm
Alias
ABO
Age
3
30
71
55
13
15
HLA A1
4
6
9
Antibodies A
Antibodies B
7
6
Antibodies Bw
6
2
401
1
1
Antibodies DQ
MedIssues
Gender
Recipient
Center
HLA A2
HLA B1
HLA B2
HLA DR1
HLA DR2
Antibodies DP
Antibodies DR-51
Antibodies DR-53
Gender
HtCm
HtFt
HtIn
Race
WtKilos
WtLbs
58.9
WtKilos
WtLbs
NDD/DD
NDD
Will Transfer?
NeedsAid
Creatinine Clearance
Non-A1 ABO
Yes
100
Not Indicated
2|4|7|8|9
3|9|17
Antibodies DR-52
HtIn
Sites Willing to Travel to: ALL
TrvlNotz
24
Antibodies Cw
HtFt
Race
11
26
27
35
1
103
Antibodies DR
MedIssues
F
160
Stanford
SUR2040
O
47
S/P kidney transplant in 11/1993. Currently receiving IVIg for
desensitization.
M
177
Caucasian
76
No
Accepts Shipped Kidney? Yes
Max Donor Age
65
Min Donor Age
Kidney Failure Reason
Titers
0
IgA Nephropathy
Not Indicated
Match Offer Contacts
UCLA Contacts
Category
Exchange Coordinator
Exchange Coordinator Backup
Donor Coordinator
Recipient Coordinator
Medical Director
Surgical Director
Program Administrator
Financial Coordinator
Lab Director
Lab Director Backup
Media Relations
Media Relations Backup
OPO Primary
OPO Primary Backup #1
OPO Primary Backup #2
Name
Suzanne McGuire
Tonya Frazier
Dr. Gabriel Danovitch
Dr. Jeff Veale
Nanci Flores
Lilly Villalta
Elaine Reed
Mike Cecka
Lori Serra
Prasad Garimella
Tom Mone
Phone
310-794-0696
310-794-0609
Cell Phone
Pager
Email
[email protected]
[email protected]
[email protected]
[email protected]
310-794-2688
310-794-3494
310-948-2240
213-229-5603
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
This file consists of center-specific sheets. Click the sheet tab below associated with the center for which you need contact information.
UW Experience
 Joined NKR 12/1/10
 Have completed 11 transplants, to date,
successfully
 Have completed 7 non directed donors
(humanitarian)
 1st pair entered 12/6/10
 16 link chain
 16 donors and 16 recipients
 1st pair completed 2/10/11
 UW donor in the OR at 3 am.
 UW recipient in the OR at 2pm.
 UW donor kidney to UCSF
 UW recipient kidney from Pittsburgh
 UW donor and recipient (creat 1.4) doing well
The Process
In Summary
 National Kidney Registry has completed the most
paired kidney transplants compared to any other
paired exchange program
 Excellent support
 Fast paced/high energy
 Have assisted UW in completing 11 more
transplants. Eleven patients transplanted that,
may, otherwise not have received. Two of those
patients highly sensitized.
 Have assisted UW in started 7 chains (with non
directed donors), which has cumulated in 27,
additional, transplants throughout the United
States
But, it takes a team to make it
successful…
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Tony D’Alessandro
Luis Fernandez
John Pirsch
Aji Djamali
Transplant surgeons and fellows
Chris Lillesand
Sara O’Loughlin
Elaine Synder and B4/6 staff
HLA staff especially Dave Lorentzen and Katie Meuer
OPO staff especially Mike Anderson
OR team especially Jeff Fenne and Tom Coughlin
Mike Armbrust
Jan Pankow
Kris Patterson
Billing and Fiscal, especially Mary Beth Benson
Data staff, especially Bridget Welch
Transplant Coordinators
Erinn Pullen
Rebecca Hays