Introduction: Many barriers currently stand in the way of achieving international kidney exchange including: financial, regulatory, logistical, cultural, immunological and legal barriers.
Methods: The Alliance for Paired Kidney Donation serves patients in 15 countries. Ten of these countries have participated in Global Kidney Exchange (GKE) transplants in which either living donors, their kidneys or recipients have traveled internationally to achieve successful living donor kidney transplantation (LDKT). In all cases, barriers were present that prevented LKDT in the donor or recipient country of origin.
Results: Between January of 2015 and March of 2024, GKE has produced 12 chains and 6 cycles that has provided LDKT for 21 international patients from 10 countries to be transplanted, as well as 42 LDKT for patients in the United States (US). GKE chains lengths have ranged from 1 to 11; cycles were length 2 or 3. Twelve GKE transplants overcame immunologic barriers, 3 financial barriers, and 6 both immunologic and financial barriers. GKE has involved 22 US transplant centers across 18 states and 43% of recipients were minorities. For US recipients 14.3% had blood type (BT)-A, 57% BT-0, 14.3% BT-B, and 14.3% BT-AB; for international recipients 43% had BT-A, 43% BT-O, 9% BT-B and 5% BT-AB. The PRA was 0-20% for 29 patients, 21-70% for 15 and > 81% for 19 (11 international). One international child was transplanted through the program. International pairs were funded by a combination of self-pay, insurance and philanthropy. Transplanting 42 US patients saved US healthcare payers $8-12M vs. dialysis. International recipients have 100% 3-year patient and graft survival and all international donors are alive and have normal creatinine and blood pressure.
Conclusion: GKE overcomes financial and immunological barriers to transplantation. Savings from avoided dialysis offers scalability. Our program ensures transparency of international pair selection, emphasis on donor safety, and assurance of longterm immunosuppression for recipients as prerequisites for sustainability.