living donor options: paired kidney exchange karen m. miller, rn, bsn, cctc october 8, 2011
TRANSCRIPT
Living Donor Options: Paired Kidney Exchange
Karen M. Miller, RN, BSN, CCTCOctober 8, 2011
I have no conflict of interest nor will I be discussing any off-label use of drugs or products
Many paired kidney exchanges to choose from
New England Program for Kidney Exchange (NEPKE)
Hopkins group Alliance for Paired Kidney Exchange UNOS University of Michigan Paired Kidney North Central Donor Exchange
Cooperative MatchingDonors
National Kidney Registry
Founder, wife and family (six initial donors) were incompatible with daughter
Entered every paired exchange in the United States
No matches found in paired exchange There had to be a better solution…
Its Success
501 Non profit corporationStarted with $2,500,000 in contributionsFirst transplants were facilitated in 2/08Over 40 donor chains have been started to date349 transplants have been facilitated to date10 Month Average Wait Time for Match/XplantMore swaps than any organization in the world
Evolution of Paired Exchange
Two Pair Exchange
Three Pair Exchange
Non DirectedAltruistic Donor
D D
R R
D D D
R R R
D R
DR
D R
DR
D
Cluster #1
Cluster #2
R
R
R
D
D
Etc.
Cluster #3
How Has NKR Been Able To Facilitate So Many Paired Exchange Transplants?
Daily Match Runs Faster matching Real-time 12 deep matching engine… Modeled
after NYSE Web portal for easy pair enrollment …Fast
center startup No personal information required … Avoids
HIPAA issues Automated match offer & tracking…
Organized & efficient Majority of top centers participating…For the
greater good Not controlled by a single center… No
conflict of interest Leveraging the power of donor chains…Open &
closed clusters
Match Offer Process
Daily Match Runs
Match Offers
Emailed
Match Acceptance
Emailed
Cross Matches Initiated
Cross Matches
Completed
Surgery Date/Time
Set
Surgeries Performed
1 - 2 Days 10 Days 2-5 Weeks
Match Test Transplant
Speed to MatchEstimates based on blood type combinations & recipient PRA
Recipient Direct Donor Recipient PRA Score
Blood Type Blood Type < 50% 50%-95% > 95%
O 1 - 2 weeks 1 - 4 weeks 1 - 6 weeks
AB B 1 - 3 weeks 1 - 6 weeks unknown
- Easiest - A 1 - 4 weeks 1 - 8 weeks unknown
AB unknown unknown unknown
O 1 - 2 weeks 1 - 4 weeks 1 - 6 weeks
A B 1 - 3 weeks 1 - 6 weeks unknown
A 1 - 4 weeks 1 - 8 weeks unknown
AB unknown unknown unknown
O 1 - 4 weeks 1 - 8 weeks 1 - 12 weeks
B B 1 - 6 weeks 1 - 12 weeks unknown
A 1 - 8 weeks 1 - 16 weeks unknown
AB unknown unknown unknown
O 1 - 8 weeks 1 - 16 weeks unknown
O B unknown unknown unknown
- Hardest - A unknown unknown unknown
AB unknown unknown unknown
Participating Center Fee Schedule Center start-up & training $4,950/
one-time– Additional cost for non-standard NKR BAA $1,000/
one-time
Database management & technology support– 0 transplants facilitated over prior 12 months $100/ month– 1 transplant facilitated over prior 12 months $250/ month– 2 transplants facilitated over prior 12 months $500/ month– 3 transplants facilitated over prior 12 months $750/ month– Additional transplants facilitated prior 12 months $250/
xplant/month
Center annual membership $2,500/ year
Terms– No contract required– Service can be cancelled at any time without penalty
Match Offer Email
Match Offer Medical Information
Dnr Center NKR Center NKR Center StanfordDnr Alias PASQJ Alias PASQJ Alias SUR2040Recip Center Stanford ABO O ABO ORecip Alias SUR2040 Age 63 Age 47
Antgn Pts 0 HLA A1 3 HLA A1 11D-BT O HLA A2 30 HLA A2 26R-BT O HLA B1 71 HLA B1 27D-Age 63 HLA B2 55 HLA B2 35R-Age 47 HLA DR1 13 HLA DR1 1D-R Age Delta 16 HLA DR2 15 HLA DR2 103
R TII 100.00% HLA Bw1 4 Antibodies A 24Traveling Dnr? Ship HLA Bw2 6 Antibodies B
HLA Cw1 9 Antibodies DR
HLA Cw2 7 Antibodies Bw
HLA DQ1 6 Antibodies Cw
HLA DQ2 6 Antibodies DQ 2|4|7|8|9HLA DP1 2 Antibodies DP 3|9|17HLA DP2 401 Antibodies DR-51
HLA DR-51 1 Antibodies DR-52
HLA DR-52 1 Antibodies DR-53
HLA DR-53
MedIssues MedIssues
S/P kidney transplant in 11/1993. Currently receiving IVIg for desensitization.
Gender F Gender M HtCm 160 HtCm 177 HtFt HtFt
HtIn HtIn
Race Race Caucasian WtKilos 58.9 WtKilos 76 WtLbs WtLbs
NDD/ DD NDD Will Transfer? NoSites Willing to Travel to: ALL Accepts Shipped Kidney? YesTrvlNotz Max Donor Age 65NeedsAid Yes Min Donor Age 0Creatinine Clearance 100 Kidney Failure Reason IgA NephropathyNon-A1 ABO Not Indicated Titers Not Indicated
Click to return to Cluster
NKR Member or One Way Detail
Member or One Way: NKR PASQJ donating to Stanford SUR2040
Click to return to Center List
One-Way Donor Recipient
Match Offer Contacts
Category Name Phone Cell Phone Pager EmailExchange Coordinator Suzanne McGuire 310-794-0696 [email protected] Coordinator Backup Tonya Frazier 310-794-0609 [email protected] CoordinatorRecipient CoordinatorMedical Director Dr. Gabriel Danovitch [email protected] Director Dr. Jeff Veale [email protected] Administrator Nanci Flores 310-794-2688Financial Coordinator Lilly Villalta 310-794-3494 [email protected] Director Elaine Reed [email protected] Director Backup Mike Cecka [email protected] RelationsMedia Relations BackupOPO Primary Lori Serra 310-948-2240 [email protected] Primary Backup #1 Prasad Garimella [email protected] Primary Backup #2 Tom Mone 213-229-5603 [email protected]
This file consists of center-specific sheets. Click the sheet tab below associated with the center for which you need contact information.
UCLA Contacts
UW Experience Joined NKR 12/1/10 Have completed 11 transplants, to date,
successfully Have completed 7 non directed donors
(humanitarian) 1st pair entered 12/6/10 16 link chain 16 donors and 16 recipients 1st pair completed 2/10/11 UW donor in the OR at 3 am. UW recipient in the OR at 2pm. UW donor kidney to UCSF UW recipient kidney from Pittsburgh UW donor and recipient (creat 1.4) doing well
The Process
In Summary National Kidney Registry has completed the most
paired kidney transplants compared to any other paired exchange program
Excellent support Fast paced/high energy Have assisted UW in completing 11 more
transplants. Eleven patients transplanted that, may, otherwise not have received. Two of those patients highly sensitized.
Have assisted UW in started 7 chains (with non directed donors), which has cumulated in 27, additional, transplants throughout the United States
But, it takes a team to make it successful…
Tony D’Alessandro Luis Fernandez John Pirsch Aji Djamali Transplant surgeons and fellows Chris Lillesand Sara O’Loughlin Elaine Synder and B4/6 staff HLA staff especially Dave Lorentzen and Katie Meuer OPO staff especially Mike Anderson OR team especially Jeff Fenne and Tom Coughlin Mike Armbrust Jan Pankow Kris Patterson Billing and Fiscal, especially Mary Beth Benson Data staff, especially Bridget Welch Transplant Coordinators Erinn Pullen Rebecca Hays