Kidney and Pancreas Transplantation Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy.
IBM Thomas J. Watson Research Center, Yorktown Heights, NY.
Transplantation. 2019 Oct;103(10):2196-2200. doi: 10.1097/TP.0000000000002645.
It has been suggested that deceased donor kidneys could be used to initiate chains of living donor kidney paired donation, but the potential gains of this practice need to be quantified and the ethical implications must be addressed before it can be implemented.
The gain of implementing deceased donor-initiated chains was measured with an algorithm, using retrospective data on the pool of incompatible donor/recipient pairs, at a single center. The allocation rules for chain-ending kidneys and the characteristics and quality of the chain-initiating kidney are described.
The benefit quantification process showed that, with a pool of 69 kidneys from deceased donors and 16 pairs enrolled in the kidney paired donation program, it was possible to transplant 8 of 16 recipients (50%) over a period of 3 years. After obtaining the approval of the Veneto Regional Authority's Bioethical Committee and the revision of the Italian National Transplant Center's allocation policies, the first successful case was completed. For the recipient (male, aged 53 y), who entered the program for a chain-initiating kidney with a Kidney Donor Risk Index of 0.61 and a Kidney Donor Profile Index of 3%, the waiting time was 4 days. His willing donor (female, aged 53 y) with a Living Kidney Donor Profile Index of 2, donated 2 days later to a chain-ending recipient (male, aged 47 y) who had been on dialysis for 5 years.
This is the first report of a successfully completed, deliberate deceased donor-initiated chain, which was made possible after a thorough assessment of the ethical issues and the impact of allocation policies. This article includes a preliminary efficacy assessment and describes the development of a dedicated algorithm.
有人建议，可以利用已故捐献者的肾脏来启动活体捐献者肾脏配对捐赠链，但在实施之前，需要对这种做法的潜在收益进行量化，并解决其伦理问题。
在一个中心，使用不匹配的供体/受体对的回顾性数据，通过算法测量实施已故供体启动链的收益。描述了链终止肾脏的分配规则以及链起始肾脏的特征和质量。
效益量化过程表明，在 69 个已故捐献者的肾脏和 16 对参加肾脏配对捐赠计划的情况下，在 3 年内有可能为 16 名受者中的 8 名（50%）进行移植。在获得威尼托地区生物伦理委员会的批准和意大利国家移植中心分配政策的修订后，首例成功案例完成。对于该受者（男性，53 岁），他参加了链起始肾脏的计划，其肾脏捐献者风险指数为 0.61，肾脏捐献者概况指数为 3%，等待时间为 4 天。他的愿意捐献者（女性，53 岁）的活体肾脏捐献者概况指数为 2，在 2 天后将肾脏捐献给一名已经透析 5 年的链终止受者（男性，47 岁）。
这是首例成功完成的蓄意已故供体启动链的报告，在对伦理问题和分配政策的影响进行彻底评估后，这是可行的。本文包括初步的疗效评估，并描述了专用算法的开发。
