236:(NKR) after their daughter (age 10) lost her kidney function and needed a transplant. Both parents were incompatible and could not donate to their daughter, who later, after an extensive donor search, received a living donor kidney from her compatible cousin. Mr. Hil was the first non-physician to start/lead a KPD program and the first KPD leader to donate one of his kidneys, starting a chain that facilitated eight transplants. In 2008 the National Kidney Registry completed its first KPD transplants and implemented the next major innovation, the shipment of kidneys on commercial airlines. This breakthrough in logistics further expanded KPD. The first living donor kidney that was shipped on a commercial airline went from New York to Los Angeles and started NKR's second chain which facilitated eight transplants utilizing several bridge donors. Initially NKR provided donors with the option of traveling to the matched recipient's hospital or donating locally and having their kidney shipped. Recipients could also choose if they would accept a shipped kidney or require the donor to travel to their center to donate. Over a two-year period, these preferences shifted until nearly all recipients would accept shipped kidneys with very few donors willing to travel. By 2010 the option to have a donor travel was phased out and all kidneys that needed to be moved between centers were shipped. After several near misses and with the UNOS reporting that 1–2% of deceased donor kidney lost or mis-routed, the NKR developed the first GPS tracking systems for human organs to monitor the location of all NKR kidney shipments. The utilization of GPS tracking devices is now mandatory for all NKR shipped kidneys.
240:
compatibility are generally predictable and to ensure the prediction is accurate, a cross match test must be completed prior to the swap. In 5–10% of the cases, these cross match tests result in an unexpected positive cross match (bad) which causes a swap to fail. These swap failures are costly in terms of wasted time and testing but they are also demoralizing for the patients and donors involved in the cancelled swap. The
Methodist program implemented the first donor blood cryo-preservation allowing the rapid cross matching of pairs in a swap without requiring fresh blood from donors. This approach accelerates the matching process, reduces swap failure rates and provides the ability to speculatively cross match potential donors for highly sensitized patients, leading to shorter wait times and more transplants for highly sensitized patients. Although the merits of using cryo-preserved donor blood for cross matching were clear, it proved difficult for multi-center KPD programs to implement cryo-preservation due to the complexity of the multi-center environment. The only U.S. multi-center KPD program that successfully implemented cryo-preservation was the National Kidney Registry but only after establishing a central lab and investing three years in software development. The second important innovation implemented in San Antonio was the re-engineering of the donor/patient intake process to educate and enroll compatible pairs in KPD so that the compatible recipient can get a better matched donor kidney. The development of cryo-preservation based cross matching and the systematic enrollment of compatible pairs has helped make San Antonio one of the leading KPD centers in the U.S.
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the number of transplants that could be performed. A bridge Donor is someone whose paired recipient has received a kidney but does not donate for some period of time (generally 1 week to 3 months). Just like Domino Chains increased KPD transplants, the utilization of bridge donors also dramatically increased KPD transplants because chains could now be organized over several months and avoid the logistical limitations of performing all surgeries on one day. In 2007, the APD completed the first NEAD chain. That same year, the U.S. Congress passed the
Charlie Norwood Act which clarified that paired exchange was legal. Prior to the passage of this law, many in the U.S. transplant community feared that KPD was unlawful due to the prohibition of "valuable consideration" as articulated in the NOTA laws that govern the U.S. transplant industry. With the passage of the Charlie Norwood Act, many more KPD programs were launched in the U.S. including the UNOS KPD program which was government sponsored with funding from deceased donor registration fees and charitable contributions.
220:, led the industry in early innovations including the critical "domino chain" breakthrough which allowed Good Samaritan donors to start chains, dramatically increasing the number of pairs that could be matched in a swap compared to the loop approach that was used previously. Once the Hopkins team began organizing Domino Chains, these swaps became larger and began attracting national media attention due to the massive complexity and significant impact of these large swaps. Unlike the Hopkins program that was hospital based, NEPKE was launched within the New England Organ Procurement Organization which served several states in the North East. The PDN and APD organizations were founded by transplant surgeons but attempted to create networks of transplant centers that would work together to pool their incompatible pairs, much like NEPKE but without OPO support.
266:
believe it may be driven by better HLA and donor age matching and/or better avoidance of recipient antibodies. Researchers have determined that the improved outcomes from NKR are not driven by a center effect although most of the top U.S. transplant centers participate in KPD via NKR. The improved outcomes from KPD transplants are opening the door for more compatible pair participation in KPD, allowing patient with compatible living donor to essentially trade-up and get a better matched kidney. The increasing enrollment of compatible pairs in KPD is shortening the wait times for incompatible pairs with hard to match blood type combinations (e.g. "O" patients with "A" donors) and driving more matches for highly sensitized patients (e.g. cPRAs > 90%).
209:
approach to facilitate transplants for incompatible donor–recipient pairs. In 1999, the first KPD transplants were performed in Europe followed by the first KPD transplants in the United States in 2000. Over the next ten years the United States would become the most competitive KPD market in the world with more than a dozen KPD programs commencing operations and many KPD programs failing. Outside of the United States, most of the KPD programs have been organized or sponsored by governments which has limited innovation in these programs. Three of the important early KPD programs in the U.S. were the
Hopkins program led by Dr. Montgomery and Dr. Segev, the New England Paired Kidney Exchange (NEPKE) led by Dr. Delmonico and Professor
253:
recipient transplants which further alleviated scheduling challenges for paired donors. In 2014, the
National Kidney Registry set a new record by organizing a swap that included 70 surgeries completing over two months. That same year, the NKR completed its first long term Advanced Donation whereby a donor donated on behalf of his grandson who may develop kidney failure 10–20 years in the future. Mr. Hil, the founder of the NKR, was the second donor to donate his kidney through this program. In 2015, the National Kidney Registry completed 360 KPD transplants which accounted for 62% of all U.S. KPD transplants and more than the combined volume of all other KPD programs in world.
270:
effects from post-transplant anti-rejection medications. Equally important, better HLA matching reduces the number of antibodies that a transplant recipient will create making it easier to get a second, third or fourth transplant. This issue is critical for young transplant recipients who have a life expectancy that is longer than the expected graft survival (i.e. how long a transplanted kidney lasts). Deceased donor kidneys typically last 5–15 years and living donor kidneys typically last 10–30 years.
262:
where greater CIT is correlated with lower graft survival rates. Prior to KPD, there was no reason to ship living donor kidneys and therefore, there was no understanding of the impact of CIT on outcomes. This concern proved to be unfounded as more living donor kidneys were shipped and the research demonstrated that CIT had no negative impact on KPD outcomes.
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For compatible pairs, not only does a better match lead to a better outcome, but it also directly helps other patients with incompatible donors find a match and get transplanted. A favorable blood type compatible pair (i.e. O donor with non-O recipient) will facilitate at least one and as many as six
223:
In 2006, the APD conceived of a critically important innovation called "NEAD Chains" that amplified the matching power of Domino Chains by allowing Bridge Donors to extend chains. Prior to the utilization of Bridge Donors, a chain of transplant surgeries would be completed in one day, which limited
35:
and age matching are correlated with lower lifetime mortality and longer lasting kidney transplants, many compatible pairs are also participating in swaps to find better matched kidneys. In the United States, the
National Kidney Registry organizes the majority of U.S. KPD transplants, including the
278:
When KPD first started, the focus was only on enrolling incompatible donor–recipient pairs. As paired exchange grew and the process became faster and more reliable, patients with compatible donors that wanted a better match, began enrolling in KPD. Researchers have identified that a better matched
252:
In 2012 the
National Kidney registry organized the largest swap in history which included 60 surgeries, completed over five months. That same year the NKR initiated the Advanced Donation Program (ADP) which inverted the role of the bridge donor – now donors were donating in advance of their paired
269:
Researchers have also discovered that better HLA matching not only leads to longer lasting transplants, but is also correlated with lower patient mortality rates because better matched kidneys require less immunosuppression and less immunosuppression reduces nephrotoxicity and other negative side
261:
Concerns regarding the negative impact that Cold
Ischemic Time (CIT) may have on graft survival, due to the shipment of the kidneys, initially caused concern in the transplant industry and slowed the adoption of KPD. This concern regarding CIT originated from deceased donor transplant experiences
243:
By 2010 the UNOS KPD program had completed its first swap and the NEPKE and PDN programs folded due to funding issues and increased regulatory requirements imposed on U.S. KPD programs by CMS and UNOS. During this time, the NKR developed the first donor preselect system that allowed donors to be
265:
After completing over 1,000 KPD transplants, it was discovered that NKR's graft survival rates were actually better than the graft survival rates of the typical U.S. non-KPD living donor transplants. Researchers are working to better understand why NKR KPD transplants have superior outcomes and
248:
concept to KPD. The preselect concept eliminated the need to use supercomputers for match runs because the number of valid one-ways was dramatically reduced. The donor preselect concept developed by the NKR was quickly copied by other major KPD programs and changed the nature of the mathematics
208:
The first paper outlining the concept of paired exchange was authored by FT Rapaport and published in 1986. The first recorded paired exchange transplants were organized in South Korea by Dr. Park beginning in 1991. For nearly a decade, only Park and his team in South Korea utilized this novel
239:
In 2009 several more key innovations were yielding results at a single center KPD program, the
Methodist Transplant Institute, in San Antonio led by Dr. Adam Bingaman. Prior to Dr. Bingaman's work, KPD was built on the notion that the results of a cross match test to determine donor–recipient
53:
Swaps of kidneys come in two distinct types: cycles and chains. Cycles only include donors who are paired with a patient so that the donor donates a kidney only if their patient receives a kidney in the swap. Chains are initiated by non-directed donors. These donors, also known as unpaired or
295:
Advanced
Donation, which began in 2012 and expanded in 2014 to include Voucher donations and swap saver cases, expanded so rapidly that by 2017 Advanced Donation accounted for nearly half of the chain starts in the United States. As adoption of Advanced Donation increased, due to the timing
44:
According to a 2019 study, kidney exchanges improve overall transplant quality, which leads to fewer transplant failures. The exchanges also reduce waiting times for patients needing kidney transplants. The study found that the health care cost savings of kidney exchanges are substantial.
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kidney is correlated with better outcomes. Specifically a better matched kidney lasts longer and may allow for a lower dosage of post-transplant immunosuppressive medications. Also a better matched kidney transplant is correlated with a lower lifetime mortality rate.
930:
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additional transplants. Compatible pair participation is the fastest growing segment of KPD and holds the promise of facilitating better matches for patients with compatible donors while limiting KPD wait times to less than 12 months for patients that have a cPRA ("
71:. KPD overcomes donor–recipient incompatibility by swapping kidneys between multiple donor–recipient pairs. KPD is also being used to find better donor–recipient matches for compatible pairs who want a lower lifetime mortality and longer lasting transplant.
296:
advantages that made donation surgery more convenient for the donor, the size and complexity of KPD swaps were reduced, with the logical extension of this trend being the eventual elimination of traditional chain and loop swaps, replaced by 1-deep chains.
40:
and the second, even larger swap, included 70 participants and was completed in 2014. Other KPD programs in the U.S. include the UNOS program, which was launched in 2010 and completed its 100th KPD transplant in 2014, and the
Alliance for Paired Donation.
1435:
Butt, F. K.; Gritsch, H. A.; Schulam, P.; Danovitch, G. M.; Wilkinson, A.; Del Pizzo, J.; Kapur, S.; Serur, D.; Katznelson, S. (2009-09-01). "Asynchronous, out-of-sequence, transcontinental chain kidney transplantation: a novel concept".
934:
1479:
Treat, Miller, Kwan, Connon, Maliski, Hicks, Williams, Whitted, Gritsch, McGuire, Mone, Veale (2014-09-22). "Outcomes of shipped live donor kidney transplants compared with traditional living donor kidney transplants".
66:
to a friend or family member cannot donate due to blood type or antibody incompatibility. Historically, these donors would be turned away and the patient would lose the opportunity to receive a life-saving
213:
and the Ohio Organ Consortium which later reorganized as two competing programs, the Paired Donation Network (PDN) led by Dr. Woodle and the Alliance for Paired Exchange (APD) led by Dr. Rees.
821:
Rees, Michael A.; Kopke, Jonathan E.; Pelletier, Ronald P.; Segev, Dorry L.; Rutter, Matthew E.; Fabrega, Alfredo J.; Rogers, Jeffrey; Pankewycz, Oleh G.; Hiller, Janet (2009-03-12).
368:"HLA Matching Trumps Donor Age: Donor-Recipient Pairing Characteristics that Impact Long-Term Success In Living Donor Kidney Transplantation in the Era of Paired Kidney Exchange"
1374:
Debout, Foucher, Trebern-Launay, Legendre, Kreis, Mourad, Garrigue, Morelon, Buron, Rostaing, Kamar, Kessler, Ladrie, Poignas, Blidi, Soulillou, Giral, Dantan (2014-09-17).
31:
where patients with incompatible donors swap kidneys to receive a compatible kidney. KPD is used in situations where a potential donor is incompatible. Because better donor
959:
Veale, Jeffrey L.; Capron, Alexander M.; Nassiri, Nima; Danovitch, Gabriel; Gritsch, H. Albin; Waterman, Amy; Del Pizzo, Joseph; Hu, Jim C.; Pycia, Marek (September 2017).
1523:
1421:
308:- an optimization problem faced by kidney exchange programs, aiming to arrange the exchanges in a way that maximizes the number of transplants or some other objective.
916:
1350:
1565:
Cecka, J Michael (2007-04-01). "Does flow cytometry crossmatch predict renal allograft outcome in patients with a negative antiglobulin crossmatch?".
1210:
1143:
479:
1376:"Each additional hour of cold ischemia time significantly increases the risk of graft failure and mortality following renal transplantation"
1783:
Demographic and Clinical Characteristics of 207 Non-Directed Donors Participating in Paired Exchange through the National Kidney Registry
1292:
Flechner, S. M.; Leeser, D.; Pelletier, R.; Morgievich, M.; Miller, K.; Thompson, L.; McGuire, S.; Sinacore, J.; Hil, G. (2015-10-01).
703:"Association of HLA mismatch with death with a functioning graft after kidney transplantation: a collaborative transplant study report"
1773:
Equipoise: Ethical, Scientific, and Clinical Trial Design Considerations for Compatible Pair Participation in Kidney Exchange Programs
536:"A Systematic Review of Kidney Paired Donation: Applying Lessons From Historic and Contemporary Case Studies to Improve the US Model"
535:
503:
1793:
A Systematic Review of Kidney Paired Donation: Applying Lessons From Historic and Contemporary Case Studies to Improve the US Model
1294:"The Incorporation of an Advanced Donation Program Into Kidney Paired Exchange: Initial Experience of the National Kidney Registry"
1778:
Optimizing HLA matching in a highly sensitized pediatric patient using ABO-incompatible and paired exchange kidney transplantation
1798:
Center-Defined Unacceptable HLA Antigens Facilitate Transplants for Sensitized Patients in a Multi-Center Kidney Exchange Program
244:
accepted or declined before a match was offered. This innovation was taken from the brokerage industry, essentially porting the
563:
1818:
Living donor kidney paired donation transplantation: experience as a founding member center of the National Kidney Registry
284:
961:"Vouchers for Future Kidney Transplants to Overcome "Chronological Incompatibility" Between Living Donors and Recipients"
1014:
Rapaport, F. T. (June 1986). "The case for a living emotionally related international kidney donor exchange registry".
931:"16 patients, 8 'new' kidneys, 4 hospitals: Johns Hopkins surgeons lead largest-ever 'domino donor' kidney transplant"
54:
altruistic donors, donate a kidney without any expectation of a reciprocal kidney donation to any specific patient.
1853:
Does flow cytometry crossmatch predict renal allograft outcome in patients with a negative antiglobulin crossmatch?
653:
1677:"Organ Procurement and Transplantation Network and Scientific Registry of Transplant Recipients 2010 Data Report"
960:
1758:
The following academic publications highlight the most significant innovations and results in the field of KPD.
1618:"A lifetime versus a graft life approach redefines the importance of HLA matching in kidney transplant patients"
1187:
1616:
Meier-Kriesche, Herwig-Ulf; Scornik, Juan C.; Susskind, Brian; Rehman, Shehzad; Schold, Jesse D. (2009-07-15).
233:
36:
largest swaps. The first large swap was a 60 participant chain in 2012 that appeared on the front page of the
1867:
1817:
1807:
305:
32:
1847:
1788:
Outcomes of shipped live donor kidney transplants compared with traditional living donor kidney transplants
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68:
28:
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First Academic Paper published on “Chronological Incompatibility” outlining the ADP Voucher Program”
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1023:
988:
980:
852:
844:
776:
732:
724:
678:
634:
397:
1848:
Asynchronous, Out-of-Sequence, Transcontinental Chain Kidney Transplantation: A Novel Concept
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1688:
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895:
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387:
379:
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1872:
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needed to support KPD by dramatically reducing the number of one-way match possibilities.
1762:
794:
1351:"'Gift certificate' enables kidney donation when convenient and transplant when needed"
614:
392:
367:
1049:
822:
416:
Kidney Transplant Activity from Living Donors in 2010 (Absolute Numbers, 81 Countries)
1861:
1852:
1772:
1693:
1676:
1449:
1073:
719:
702:
334:"Compatible Pairs - National Kidney Registry - Facilitating Living Donor Transplants"
210:
1787:
1718:
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917:"Johns Hopkins Leads First 16-Patient, Multicenter "Domino Donor" Kidney Transplant"
1792:
1509:
1335:
1000:
881:
864:
1777:
1659:
1211:"First NY–to–LA living-donor transplant chain results in triple kidney transplant"
366:
Milner; Melcher; Lee; Veale; Ronin; D'Alessandro; Hil; Fry; Shannon (2016-07-15).
383:
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1617:
1255:
1094:
976:
245:
1843:
The National Kidney Registry: Transplant Chains - Beyond Paired Kidney Donation
1782:
62:
More than one-third of potential living kidney donors who want to donate their
564:"100th living donor kidney transplant arranged through OPTN/UNOS KPDPP | UNOS"
1768:
The Incorporation of an Advanced Donation Program into Kidney Paired Exchange
1702:
1643:
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1457:
1319:
1027:
984:
848:
728:
673:
638:
157:
National Kidney Registry organizes its first transplants on Valentine's Day
149:
Charlie Norwood Living Organ Donation Act clarifies legality of KPD in U.S.
1710:
1651:
1594:
1501:
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1401:
1327:
1144:"Hopkins Performs Historic "Six-Way Domino" Kidney Transplant - 04/08/2008"
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992:
856:
780:
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401:
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National Kidney Registry completes largest chain involving 60 participants
839:
771:
754:
630:
1808:
Chain Transplantation: Initial Experience of a Large Multicenter Program
1578:
1392:
125:
Hopkins completes KPD transplants and begins first KPD program in U.S.
1493:
1310:
1118:
588:
1763:
ABO-Incompatible Kidney Transplants: Twice as Expensive, Half as Good
117:
First KPD transplants performed in U.S. at the Rhode Island Hospital
63:
654:"Kidney Paired Donation and Optimizing the Use of Live Donor Organs"
415:
189:
National Kidney Registry sets new record with 70 participant chain
1256:"National Kidney Registry Initiates Donor Blood Cryo-Preservation"
1119:"About Alliance for Paired Kidney Donation : Matching Donors"
589:"About Alliance for Paired Kidney Donation : Matching Donors"
882:"H.R. 710 (110^th): Charlie W. Norwood Living Organ Donation Act"
1803:
Kidney Transplant Chains Amplify Benefit of Nondirected Donors
418:(Report). Global Observatory on Donation and Transplantation
1823:
Boosting Renal Transplantation with Kidney Paired Donation
502:
Pitts; Louszko; Cappetta; Effron; Valiente (15 Apr 2015).
1813:
The National Kidney Registry: 175 Transplants in One Year
165:
Hopkins leads first 16 patient multicenter Domino Chain
1838:
National Kidney Registry: 213 Transplants in Three Years
109:
First European KPD transplants performed in Switzerland
652:
Segev; Gentry; Warren; Reeb; Montgomery (20 Apr 2005).
440:(Report). Organ Procurement and Transplantation Network
141:
NEAD chain started by APD utilizing first bridge donor
504:"Changing Lives Through Donating Kidneys to Strangers"
823:"A Nonsimultaneous, Extended, Altruistic-Donor Chain"
101:
First KPD program started in South Korea by Dr. Park
1833:Managing Finances of Shipping Living Donor Kidneys
765:(7). Nephrol Dial Transplant (2011): 2091–2099.
216:The Hopkins program, which was based out of the
1050:"Hopkins Medicine Magazine - Circling the Dome"
615:"Do Kidney Exchanges Improve Patient Outcomes?"
933:. The JHU Gazette. 20 Jul 2009. Archived from
438:Transplant:Donor Relation by Transplant Center
133:Dutch established first national KPD program
8:
1522:: CS1 maint: multiple names: authors list (
1420:: CS1 maint: multiple names: authors list (
795:"Johns Hopkins Gazette | November 27, 2006"
619:American Economic Journal: Economic Policy
1828:Kidney Paired Donation: Something Special
1692:
1633:
1391:
1309:
838:
770:
718:
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462:(Report). National Kidney Registry. 2015.
391:
173:UNOS organizes its first KPD transplants
1235:"NKR Introduces GPS Tracking Technology"
753:Wallis; Samy; Roth; Rees (31 Mar 2011).
460:Paired Exchange Results Quarterly Report
78:
1258:. National Kidney Registry. 2014-12-02.
318:
1515:
1413:
954:
952:
748:
746:
232:In 2007 Garet and Jan Hil founded the
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1560:
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1535:
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919:. Johns Hopkins Medicine. 7 Jul 2009.
876:
874:
816:
814:
759:Nephrology, Dialysis, Transplantation
696:
694:
692:
361:
359:
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7:
701:Opelz, G.; Döhler, B. (2012-11-01).
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497:
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328:
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285:Calculated panel reactive antibodies
1681:American Journal of Transplantation
1567:Nature Clinical Practice Nephrology
1438:American Journal of Transplantation
1298:American Journal of Transplantation
707:American Journal of Transplantation
1270:"United Network for Organ Sharing"
1188:"United Network for Organ Sharing"
480:"60 Lives, 30 Kidneys, All Linked"
14:
540:Wharton Research Scholars Journal
27:, is an approach to living donor
1694:10.1111/j.1600-6143.2011.03886.x
1450:10.1111/j.1600-6143.2009.02730.x
720:10.1111/j.1600-6143.2012.04226.x
93:KPD first suggested by Rapaport
1164:"National Organ Transplant Act"
827:New England Journal of Medicine
1:
534:Ellison, Blake (2014-05-16).
384:10.1097/TXD.0000000000000597
1635:10.1097/TP.0b013e3181a9ec89
1016:Transplantation Proceedings
977:10.1097/TP.0000000000001744
478:Sack, Kevin (18 Feb 2012).
1889:
1543:"National Kidney Registry"
1237:. National Kidney Registry
896:"National Kidney Registry"
613:Teltser, Keith F. (2019).
1737:National Kidney Registry
1733:"Medical Board Policies"
1482:Transplant International
884:. govtrack. 21 Dec 2007.
755:"Kidney paired donation"
674:10.1001/jama.293.15.1883
234:National Kidney Registry
1054:www.hopkinsmedicine.org
306:Optimal kidney exchange
372:Transplantation Direct
218:Johns Hopkins Hospital
29:kidney transplantation
17:Kidney paired donation
1687:: 1–156. 2012-01-01.
840:10.1056/NEJMoa0803645
506:. ABC News Nightline.
1380:Kidney International
1022:(3) Suppl. 2): 5–9.
631:10.1257/pol.20170678
1579:10.1038/ncpneph0405
1393:10.1038/ki.2014.304
1215:www.uclahealth.org
1123:paireddonation.org
1095:"Steve Woodle, MD"
772:10.1093/ndt/gfr155
593:paireddonation.org
338:kidneyregistry.org
287:") less than 98%.
1494:10.1111/tri.12405
1349:Rivero, Enrique.
1311:10.1111/ajt.13339
1304:(10): 2712–2717.
1099:www.cecentral.com
833:(11): 1096–1101.
713:(11): 3031–3038.
667:(15): 1883–1890.
291:Advanced Donation
201:
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1444:(9): 2180–2185.
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1125:. 11 August 2015
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971:(9): 2115–2119.
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595:. 11 August 2015
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274:Compatible pairs
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1754:Further reading
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1622:Transplantation
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1564:
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1488:(11): 1175–82.
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965:Transplantation
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228:Break out phase
206:
77:
60:
51:
25:paired exchange
12:
11:
5:
1886:
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1868:Organ donation
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1573:(3): 136–137.
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1386:(2): 343–349.
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484:New York Times
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937:on 4 May 2017
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1757:
1740:. Retrieved
1736:
1727:
1684:
1680:
1628:(1): 23–29.
1625:
1621:
1611:
1570:
1566:
1546:. Retrieved
1518:cite journal
1485:
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1441:
1437:
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1416:cite journal
1405:. Retrieved
1383:
1379:
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1358:. Retrieved
1354:
1344:
1301:
1297:
1287:
1276:. Retrieved
1264:
1250:
1239:. Retrieved
1229:
1218:. Retrieved
1214:
1205:
1194:. Retrieved
1182:
1171:. Retrieved
1169:. 1984-10-19
1158:
1147:. Retrieved
1138:
1127:. Retrieved
1122:
1113:
1102:. Retrieved
1098:
1089:
1078:. Retrieved
1076:. 2008-09-01
1074:"Alvin Roth"
1068:
1057:. Retrieved
1053:
1044:
1019:
1015:
1009:
968:
964:
939:. Retrieved
935:the original
925:
911:
900:. Retrieved
898:. 2008-02-20
890:
830:
826:
802:. Retrieved
799:pages.jh.edu
798:
789:
762:
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710:
706:
664:
660:
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622:
618:
608:
597:. Retrieved
592:
583:
572:. Retrieved
570:. 2014-07-10
568:www.unos.org
567:
558:
547:. Retrieved
543:
539:
483:
454:
442:. Retrieved
432:
420:. Retrieved
410:
375:
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341:. Retrieved
337:
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246:limit order
1862:Categories
1742:2023-05-06
1548:2016-08-23
1407:2016-08-23
1360:2016-08-25
1278:2016-08-26
1241:2016-08-23
1220:2016-08-25
1196:2016-08-25
1173:2016-08-23
1149:2016-08-25
1129:2016-08-26
1104:2016-08-26
1080:2016-08-26
1059:2016-08-26
902:2016-08-26
804:2016-08-26
599:2016-09-12
574:2016-09-12
549:2016-08-23
378:(7): e85.
343:2016-08-26
313:References
211:Alvin Roth
204:Early days
69:transplant
1703:1600-6143
1644:1534-6080
1587:1745-8331
1458:1600-6143
1320:1600-6143
1028:0041-1345
985:1534-6080
849:0028-4793
729:1600-6143
639:1945-7731
1719:11614703
1711:22107249
1652:19584676
1603:38509513
1595:17262074
1502:25052215
1466:19563335
1402:25229341
1328:26012533
1036:11649919
993:28333861
857:19279341
781:21454351
737:22900931
683:15840863
402:27830179
300:See also
257:Outcomes
1510:2156607
1336:7329106
1001:3325450
865:2581617
393:5087568
75:History
58:Reasons
1873:Kidney
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1709:
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1660:970714
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85:Event
64:kidney
23:), or
1715:S2CID
1656:S2CID
1599:S2CID
1506:S2CID
1332:S2CID
1273:(PDF)
1191:(PDF)
1167:(PDF)
997:S2CID
861:S2CID
657:(PDF)
444:6 Apr
422:1 Jun
194:2017
186:2014
178:2012
170:2010
162:2009
154:2008
146:2007
138:2007
130:2004
122:2001
114:2000
106:1999
98:1991
90:1986
82:Year
1707:PMID
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1524:link
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1398:PMID
1324:PMID
1316:ISSN
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1024:ISSN
989:PMID
981:ISSN
943:2016
853:PMID
845:ISSN
777:PMID
733:PMID
725:ISSN
679:PMID
661:JAMA
635:ISSN
446:2016
424:2016
398:PMID
1689:doi
1630:doi
1575:doi
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1446:doi
1388:doi
1306:doi
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969:101
835:doi
831:360
767:doi
715:doi
669:doi
665:293
627:doi
544:107
388:PMC
380:doi
33:HLA
21:KPD
1864::
1735:.
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1683:.
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346:.
19:(
Text is available under the Creative Commons Attribution-ShareAlike License. Additional terms may apply.