Bootcongres

Background: During the past decade alternative living kidney donation programs have been introduced in our centre: cross-over donation, altruistic and domino-paired donation and ABO incompatible transplantation. During the last 5 years 25% of transplantations were via an alternative program, which increased the absolute number of transplantations performed. How did alternative programs influence acceptance of couples? Methods: Between January 2000 and September 2013 1864 patients have been transplanted in our centre: 678 deceased donor and 1186 living donor (LD) transplantations. In direct donation the willing donor becomes the actual donor for the intended recipient, in cross-over and domino-donation the willing donor donates to another recipient. The relationship between living willing donor and intended recipient was studied. Results: Out of 1186 LD transplantations 906 were direct and 280 were alternative program transplantations. There were 63 ABO incompatible transplantation, 96 patients received a kidney from an altruistic donor, 63 via domino-paired donation and 60 via the cross-over program. Waiting list recipients who received a living donor kidney (n=96) were excluded as they did not bring in a living donor. 1090 couples remained of whom 184 couples participated in alternative living donation programs. Not genetically related donors (468) were partners (350) or other non-related donors (118). Genetically related donors (622) were sibs (250), parents (214), children (130) and other family members (28). Only 9.5% of genetically related couples participated in alternative donation programs and 90.5% in direct living donation program. However, 27.1% of non-genetically related couples participated in alternative donation programs and 72.9% in direct donation program (p<0.001). In the direct donation program 62.3% of couples were genetically related and 37.7% of couples were not genetically related. However, in alternative donation programs 31.7% of couples were genetically related and 68.3% of couples were not genetically related (p<0.001).

Conclusion: Alternative living donation programs increase the opportunity for non-genetically related couples to participate in living donation programs.