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    Kidney Donation Types

    Types of Living Kidney Donation

    There are three types of living kidney donation; direct donation, paired exchange donation and altruistic donation. All living donors begin the donation process by completing our living donor questionnaire at Opens new window

    • Direct Donation
      With direct donation, the donor generally knows the recipient and donates directly to them. If the donor is compatible, the donor's kidney can be transplanted directly into the recipient. One problem with direct donation is that direct donors are often incompatible or poorly compatible with their intended recipients - this means they are not the right blood type or do not pass a cross match test with the intended recipient. However, a donor can still help their intended recipient get a transplant if they are incompatible by participating in a paired exchange.

    • Paired Exchange Donation (SWAP)
      A donor will donate their kidney to another recipient in exchange for a compatible kidney for their loved one. In the example below, the first pair, a mother and her son are incompatible. The second pair, a husband and his wife are also incompatible. In this exchange, the mother donates to the wife of the second pair and the husband donates to the son in the first pair. Often compatible pairs enter into a paired exchange to get a better match donor.

    • Non Directed Donor (altruistic donor)
      With altruistic donation, the donor is giving to a stranger which initiates a chain of transplants. Chains are a way for one altruistic donor (aka Non Directed Donor) to help many patients get transplanted. Chains are also revolutionizing the paired exchange process by facilitating better donor-recipient matches including some six antigen matches, which is important because a great match allows the transplanted kidney to last longer.
      Many altruistic donors choose to start chains because it is a way to help more than one person suffering from kidney failure. One chain typically facilitates anywhere from 2 to 20 transplants.

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    Kidney Paired Donation

    Kidney paired donation is an option for living donor pairs who are not compatible with each other. Previously, people with kidney failure who had an incompatible donor(s) needed to wait for a deceased donor. This wait can be lengthy. However, with kidney paired donation, kidneys can be “exchanged” between pairs, making multiple compatible living donor transplants possible.

    California Pacific Medical Center is at the forefront of kidney paired donation. Our team performed its first paired donor transplant in 2003 and made history in 2011 as the first California transplant program to perform 5 paired donor transplants in one day. Our team is also part of a UNOS Kidney Paired Donation pilot program Opens new window.

    While it is not possible to find a compatible donor-recipient pair for everyone interested in a paired donation, enrollment in this program could make an excellent opportunity available.

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    How Does a Kidney Paired Donation Work?

    Closed Loop Paired Donation
    A traditional or "closed-loop" paired donation consists of two or more donor/recipient pairs whose blood types are not compatible with each other.

    In the illustration below, the donor is not compatible with the recipient in Pairs A and B. However, the donor in Pair A is compatible with the recipient in Pair B. Conversely, the donor in Pair B is compatible with the recipient in Pair A.

    kidney paired donation diagram

    Living Donor Chain
    The second type of paired donation is the “never-ending” living donor chain. This type of paired donation begins with a non-directed (or altruistic) donor. These donors volunteer to give one of their kidneys to anyone in need, understanding the great need for transplantable kidneys in the U.S. All non-directed donors are screened thoroughly from both medical and psychosocial perspectives. If the donor is deemed a good candidate, that individual’s name is entered into a donor registry. This registry then identifies a living donor chain where the donor’s kidney is given to a recipient. That recipient’s incompatible donor then gives his/her kidney to another recipient, thereby triggering a chain reaction that can lead to countless numbers of transplants.

    kidney transplant donor chain illustration

    If you and your donor are willing to participate in a kidney paired donation or chain, a comprehensive evaluation process begins. California Pacific's Kidney Team will complete final medical tests and schedule the transplant on a date that works with everyone.
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    Why is a Living Donor Transplant Better?

    Kidney paired donation benefits individuals awaiting a kidney transplant as it can make a compatible living donor transplant possible. A living donor transplant offers better success compared to a transplant from a deceased donor. The shorter wait for a transplant with a living donor also provides a substantial benefit.
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    What Do I Need to Do?

    Patients who are evaluated at California Pacific Medical Center, part of the Sutter Health network, are offered the option of participating in our Kidney Paired Donation Program if their living donor(s) is not compatible. Once test results confirm incompatibility with your living donor(s), the Kidney Team will offer to add your names to our Kidney Paired Donation (KPD) listing. This list helps find sets of donor/recipient pairs who can “swap” kidneys. This enables you to donate to another recipient while ensuring that your recipient also receives a living donor transplant.
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    Can Donors and Recipients Meet?

    We assume that the donor and recipient pairs will want to keep their privacy. If all individuals involved in the exchange want to meet each other, the Kidney Team can arrange it.
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    About California Pacific Medical Center

    California Pacific Medical Center, part of the Sutter Health Opens new window network, offers kidney, pancreas, liver and heart transplantation as part of our Barry S. Levin, MD Department of Transplant.

    Kidney & Pancreas Transplant Program
    California Pacific Medical Center
    2340 Clay Street
    San Francisco, CA 94115
    Tel. 415-600-1700

    Outreach locations available throughout Northern California and in Reno.
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