MARCO ISLAND, Fla.—Domino paired donation (DPD) and never-ending altruistic donor (NEAD) chains are part of a new spectrum of options for patients with end-stage renal disease (ESRD) who need renal transplants but have incompatible donors.

New data presented here at the American Society of Transplant Surgeons 9th Annual State of the Art Winter Symposium suggest that both DPD and NEAD chains may significantly expand the benefits of kidney paired-donation (KPD) to a larger number of incompatible donors. In addition, both modalities could bring desired blood-type donors into paired donation and relax reciprocal requirements that often make it difficult for some incompatible pairs to match.

“Now we have some new options for these patients,” said Robert Montgomery, MD, PhD, director of the comprehensive transplant center at Johns Hopkins Medical Institutions in Baltimore. “The results from these strategies are extremely good. The data show that patients who are not offered these options have a survival that is far less than patients who are.”

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KPD involves matching a potential kidney recipient and his or her incompatible donor to another incompatible pair. This allows the donor of each pair to give his or her kidney to the recipient of the other pair. Many incompatible pairs often remain unmatched through traditional KPD, however, so researchers have been investigating DPD and NEAD chains as possible avenues for expanding KPD through the contributions of nondirected donors.

Investigators at the United States Naval Academy in Annapolis, Md., and Johns Hopkins compared the net number of transplants for three scenarios: DPD, NEAD chains, or nondirected donors giving a kidney to someone on a waitlist to receive a deceased donor kidney.

When using the DPD approach, a nondirected donor gives a kidney to the recipient of an incompatible pair. This begins a string of simultaneous transplants that ends with a living donor giving to a recipient on the deceased donor waitlist. In the recently introduced NEAD chains concept, the last donor of the string of transplants initiated by a nondirected donor is reserved to donate at a later time.