Cross-kidney transplant, also known as a kidney paired transplant or kidney paired donation, is a promising alternative for patients who need kidney transplantation but their donors turn up to be not suitable (positive) as a result of cross-matching from blood and tissue testing. In a cross-kidney transplant, patients who cannot accept their own partner's kidney for immunological reasons are given a kidney from the partner of another patient in exchange for a kidney from their own partner. There is no difference in the medical indications between direct and indirect living donation. Instead of a long search for a new donor, patients and their unmatched donors may apply as a couple to one of the cross-kidney transplant programs and in a quite short time find a suitable match.
However, many patients requiring urgent kidney transplantation do not know what exactly is a cross-kidney transplant, what are the benefits of so-called kidney brotherhood and if this method of organ donation has some advantages over classical donor search. In this article, we will make this issue clearer for current and future kidney transplant patients.
What Is a Cross-Kidney Transplant?
Cross-kidney transplant is a solution for patients whose chosen donor (usually a sibling, partner, friend) was found to be unsuitable in the crossmatch testing which is a process involves blood group identifying, tissue typing and serum crossmatching. Usually, the solution in such a situation was to start looking for a new kidney donor. However, with a cross-kidney transplant, this step was made much easier. In kidney transplantation centers you can apply as a couple with your chosen but unsuitable donor. It is important that the donation procedures start at the same time and the choices of patients and donors for anonymity be preserved. A successful cross-kidney transplant program requires a large pool of donors and patients.
Sometimes, instead of two couples, three couples may participate in cross-kidney transplantation, ensuring that all recipients get the best organ donation possible.
Is It Easy to Find a Donor with Cross-Kidney Transplant?
Kidney paired donation is basically an exchange of organs between two live donors, who are ABO incompatible or cross-match positive, and their intended recipients. The aim is the generation of suitable transplants providing an improvement in the quality of life and longevity. Paired donation may expand the living donor pool by supplying a successful alternative strategy for incompatible donor-recipient couples.
For this reason, many clinics and hospitals promote cross-kidney transplant as a new, more effective way of solving the issue of the unsuitable donor.
Why Is It Called a Kidney Brotherhood?
Increasing the number of living donors is accepted as the best solution to the organ shortage problem. The clinical questions and concerns involving donor risk, informed consent, donor protection, and organ quality, have been largely answered today. It is widely recommended that living donation, rather than a deceased donation, become the first option for kidney transplantation.
A cross-kidney transplant is not treated as a mechanical procedure. Rather, hospitals emphasize both couples involved in kidney transplantation getting to know each other before the organ donation. Hence, the term ‘kidney brotherhood' – after all, recipients will get a cross-kidney transplant from one another's donor. It may create a bond between two couples and in such a friendly atmosphere, going through the process of kidney transplantation will be relatively easier and more pleasant.
Where Can I Sign Up for Cross-Kidney Transplant?
As we already mentioned, sometimes the couples may want to donate a kidney to each other, but as their blood type is incompatible, it cannot be possible. To solve this, some transplant centers help incompatible pairs of recipient/donors through a process called cross-kidney transplant or paired exchange, which involves two living donors and two recipients.
Since the news of kidney paired donation has spread across the globe, many countries and clinics have established cross-kidney transplant databases which allow for the more effective search of matching organ donation. You shall be able to find a kidney brotherhood program in the nearest kidney transplantation center. If not, look for national programs.
Can Cross-Kidney Transplant Promise a Successful Organ Donation?
According to the studies conducted, there is no significant difference in the short-term outcome of cross-kidney transplant compared to HLA-matched living-related donor kidney transplantation. Besides, waiting time in cross-kidney transplant is significantly shorter for easy-to-match pairs compared to deceased donor kidney transplantation.
However, as all types of kidney transplantation, kidney paired donation or cross-kidney transplant is not the ultimate key to successful organ donation, although it increases the chances of finding a suitable donor. Still, kidney transplant patients need to take medicines suppressing their immunological systems in order to prevent a donor kidney rejection. While it is a small possibility, it always exists.
This content is edited by Flymedi Medical Editors in April 2019.