Reciprocity to increase participation of compatible living donor & recipient pai

[Clark]

http://onlinelibrary.wiley.com/doi/10.1111/ajt.14275/abstract?systemMessage=Wiley+Online+Library+will+be+unavailable+on+Saturday+25th+March+from+07%3A00+GMT+%2F+03%3A00+EDT+%2F+15%3A00+SGT+for+4+hours+for+essential+maintenance.++Apologies+for+the+inconvenience.

Personal Viewpoint
Reciprocity to increase participation of compatible living donor and recipient pairs in kidney paired donation
Authors
John S. Gill, Kathryn Tinckam, Marie Chantal Fortin, Caren Rose, Kara Shick-Makaroff, Kimberly Young, Julie Lesage, Edward H. Cole, Maeghan Toews, David N. Landsberg, Jagbir Gill
American Journal of Transplantation
doi: 10.1111/ajt.14275

Abstract
Inclusion of compatible living donor and recipient pairs (CPs) in kidney paired donation (KPD) programs could increase living donor transplantation. We introduce the concept of a reciprocity based strategy in which the recipient of a CP that participates in KPD receives priority for a repeat deceased donor transplant in the event their primary living donor KPD transplant fails, and review the practical and ethical considerations of this strategy. The strategy limits prioritization to CPs already committed to living donation, minimizing the risk of unduly influencing donor behavior. The provision of a tangible benefit independent of the CP's actual KPD match avoids many of the practical and ethical challenges with strategies that rely on finding the CP recipient a better matched kidney that might provide the CP recipient a future benefit to increase KPD participation. Specifically the strategy avoids the potential to misrepresent the degree of future benefit of a better matched kidney to the CP recipient, and minimizes delays in transplantation related to finding a better matched kidney. Preliminary estimates suggest the strategy has significant potential to increase the number of living donor transplants. Further evaluation of the acceptance of this strategy by CPs and by wait-listed patients is warranted.