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Image demonstrating principles of paired kidney exchange 658x672
Figure 1: Paired kidney exchange transplants initiated by an altruistic donor and ultimately resulting in the initiation of a subsequent, chain by a "bridge" donor.

In the United States, the Penn Transplant Institute is a leading center for paired kidney exchange for living donor kidney transplantation, a practice that increases the likelihood of successful outcomes and abbreviates the wait for a donor kidney in patients with end-stage kidney disease.

The outcomes of kidney transplantation are optimal when the procedure is performed from living donors with compatible blood and tissue antigens. Transplanted kidneys from living donors last years longer, on average, than grafts from deceased donors.

However, blood and tissue antigen compatibility is uncommon even among related individuals, which has limited living donor kidney transplantation until recent years. Most people with end-stage kidney disease, therefore, will eventually join the waitlist for a kidney from a deceased donor in the United States, where the average time until transplant from a deceased donor is now 3.6 years due to the shortage in organ donors.

Addressing the dual challenges of incompatibility and the shortage of deceased donor kidneys requires commitment and innovation with the kidney transplant community. To this end, at the Penn Transplant Institute, all potential kidney donors and kidney transplant candidates with living donors have the chance to enroll in the Paired Kidney Exchange (PKE) Program.

PKEs play a critical role in expanding access to kidney transplantation and thereby improving outcomes by increasing the available population of potential living donors for transplant candidates, which decreases or avoids altogether the need for dialysis.

Most PKE exchanges at the Penn Transplant Institute, for example, take place within four months. The approach is also offered to compatible pairs who may choose to participate for a better age match or altruistic reasons.

Principles of Paired Kidney Exchange

Paired kidney exchanges often occur as 'chains' initiated between a "non-directed" altruistic donor and a transplant candidate to whom he or she has been matched. The chain is generally continued simultaneously with that candidate's paired donor repeating the process by donating to another matched candidate participating in the PKE program. This series of events has a domino-like effect that produces a chain of transplants that can continue for as many compatible candidates with donors that exist in the PKE pool at that time. If there are no further matches identified, the donor of the last candidate transplanted can choose to begin a new chain as a "bridge" donor when the next matched candidate is identified (see Figure 1). If bridge donation is not desirable, then the donor can donate to a lucky candidate at the top of the deceased donor wait list (at a center participating in PKE), which extends access to living donor kidney transplant and it's associated advantages to someone without a donor.

At Penn, kidney transplant candidates and donors who are willing to participate in PKE must undergo a comprehensive medical evaluation. During the evaluation, the potential living donor will complete a series of tests and visits to determine if living donor kidney transplant is safe and appropriate for the donor and recipient. Only when the team feels it is safe to proceed are the matches made and the donor and recipient surgeries scheduled.

The contact number for kidney transplant recipients and donors at the Penn Transplant Institute is 215-662-6200.

Case Study

At age 32, Mr. B had end-stage kidney disease. His uncle, Mr. C, offered to donate a kidney to him, and entered the Living Donor Kidney Program at the Penn Transplant Institute. During evaluation, he and his intended recipient were given the chance to take part in the Paired Kidney Exchange Program.

Both donor and transplant candidate agreed to the PKE option to shorten the wait for a kidney, if necessary. Subsequent testing showed that the pair were not a match, and they were enrolled in the PKE program.

Several weeks later, a transplant coordinator at the Institute contacted Mr. C and Mr. B about a potential paired kidney exchange. The coordinator explained that Mr. A, an altruistic donor, had been found compatible with Mr. B. and that a compatible recipient, Mrs. D, was found to be a match for Mr C's kidney.

The chain thus involved Mr. A donating a kidney to Mr. B, and Mr. C donating a kidney to Mrs. D. All four participants were found to be physically and psychologically prepared for transplant surgery. The four surgeries were scheduled to take place at Penn Medicine on the same day in separate operating rooms.

On the morning of the kidney exchange, Mr. A and Mr. C had surgery at the same time at Penn Medicine, and their kidneys were transplanted into Mr. B and Mrs. D, respectively, several hours later the same day.

All four patients recovered without incident and currently have functioning transplants.

Adding to the success of this exchange, Mr. E, the husband of Mrs. D, initiated a second chain of paired exchange kidney transplants two months later by donating a kidney to Mr. F, thus becoming an altruistic "bridge" donor to a new chain, paying forward his gift and making living donor kidney transplantation possible for other participants in paired kidney exchange.


Transplant Donor Evaluation

Penn Transplant Institute Kidney Transplant Program
Perelman Center for Advanced Medicine
3400 Civic Center Boulevard West Pavilion, 2nd Floor
Philadelphia, PA

Transplant Recipient Evaluation

Penn Transplant Institute Kidney Transplant Program
Perelman Center for Advanced Medicine
3400 Civic Center Boulevard West Pavilion, 2nd Floor
Philadelphia, PA 19104

Lancaster General Hospital-Suburban Pavilion
2106 Harrisburg Pike, Suite 310
Lancaster, PA

Penn Medicine Princeton
Princeton Medical Center
5 Plainsboro Road, Suite 450
Plainsboro, NJ

Penn Medicine Valley Forge
1001 Chesterbrook Boulevard
Berwyn, PA

Penn Medicine Bucks County
777 Township Line Road, Suite 200
Yardley, PA

Penn Medicine Cherry Hill
1865 Route 70 East
Cherry Hill, NJ

The contact number at the Penn Transplant Institute for kidney transplant recipients and donors is 215-662-6200.

Published on: December 20, 2019


1. LaPointe Rudow D, Warburton KM. Selection and Postoperative Care of the Living Donor. Med Clin North Am. 2016;100:599-611.

Paired Kidney Exchange at Penn Medicine

Home to kidney, liver, lung, heart, pancreas, uterine and hand transplantation programs, the Penn Transplant Institute is now a leader in the effort to increase paired kidney exchanges for kidney transplantation. In partnership with the National Kidney Registry (NKR), a consortium of 72 transplant centers nationwide, the Penn Transplant Institute took part in a kidney exchange over a 40-day period that ultimately involved 28 donors and 28 recipients. The Living Donor Kidney Program at Penn Medicine is one of a select group of US centers designated as a Donor Care Network Center of Excellence within the NKR.

The US Department of Health and Human Services has awarded the Penn Transplant Institute’s Kidney Transplant program a Silver Level Award. Penn is one of the few programs in the nation to receive this distinction, and the only transplant center in the region so awarded.

In addition to its partnership with the NKR, the Penn Transplant Institute is a member of the United Network for Organ Sharing (UNOS). We also participate in other registries such as the Alliance for Paired Donation and the UNOS Paired Donation Program, which maximize the chance at finding a match and achieving transplant with a living donor.

Penn Faculty Team

Ty B. Dunn, MD

Surgical Director of Kidney and Pancreas Transplantation

Clinical Associate of Surgery

Professor of Surgery at the Hospital of the University of Pennsylvania

Peter L. Abt, MD

Professor of Surgery at the Hospital of the University of Pennsylvania and the Children's Hospital of Philadelphia

Matthew H. Levine, MD, PhD

Associate Professor of Surgery

Ali Naji, MD, PhD

J. William White Professor of Surgical Research

Paige M. Porrett, MD, PhD

Assistant Professor of Surgery

Roy D. Bloom, MD

Medical Director, Kidney/Pancreas Transplant Program, Hospital of the University of Pennsylvania

Professor of Medicine at the Hospital of the University of Pennsylvania

Behdad David Besharatian, MD

Assistant Professor of Clinical Medicine

Melissa B. Bleicher, MD

Assistant Medical Director, Penn Kidney Transplant Program, Post-Transplant Operations, University of Pennsylvania

Director, Transplant Adolescent Transition Program, University of Pennsylvania

Associate Professor of Clinical Medicine

Simin Goral, MD

Director, Polycystic Kidney Disease Clinic

Transplant Nephrology Fellowship Director

Professor of Medicine at the Hospital of the University of Pennsylvania

Yvonne El Kassis, MD

Assistant Professor of Clinical Medicine

Mary Ann C. Lim, MD

Assistant Professor of Clinical Medicine

Peter Reese, MD, MSCE

Associate Professor of Medicine

Associate Professor of Epidemiology in Biostatistics and Epidemiology

Associate Professor of Medical Ethics and Health Policy

Deirdre L. Sawinski, MD

Assistant Medical Director, Kidney Pancreas Transplantation

Associate Professor of Medicine at the Hospital of the University of Pennsylvania

Amanda Leonberg-Yoo, MD

Director, Senior Associate Training Program

Assistant Professor of Clinical Medicine

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