Increasing the Chances of Identifying Living Kidney Donors

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CHOP’s involvement with the National Kidney Registry increases access to well-matched living donors.

In the field of kidney transplantation, there’s a notable difference based on age: Pediatric patients have a higher rate of living donors than adults. While data from 2015 for all ages of kidney transplant patients shows less than 30% were from living donors, for pediatrics, the number is closer to 50%. Children's Hospital of Philadelphia’s (CHOP) involvement with the National Kidney Registry (NKR), through a partnership with Penn Medicine, increases patients’ access to living donor options, creating better overall outcomes for patients.

Sandra Amaral, MD, MHS Sandra Amaral, MD, MHS There are reasons why living kidney donations are preferable in general, and particularly worth pursuing for pediatric patients. “Living donors are screened head to toe, so we know we’re getting a kidney from a healthy individual,” explains Sandra Amaral, MD, MHS, Medical Director of CHOP’s Kidney Transplant Program. Also, if the donor is a parent or other relative, it will often result in a better match with a reduced risk of rejection.

A healthy, well-matched donor is a factor in how long the kidney maintains function, which is important in pediatric patients. “About half of transplanted kidneys last only 10 to 12 years,” says Amaral. “Thirty years is really good.” If a patient is 65 years old when transplanted, they possibly won’t ever need another transplant. “But if you’re 2 years old, you might need three to five kidneys over your life span,” says Amaral. “If the first kidney is healthy and lasts into adulthood, there are many benefits.” Those benefits include physical ones, such as improved growth and cardiovascular health, as well as the psychosocial benefits that result from no long, stressful dialysis sessions and considerably fewer school absences.

When a willing donor isn’t a match

Although a kidney from a parent or other relative is often a good option for pediatric patients, unfortunately there are cases when family members are willing to be donors but are unsuitable. One problem can be incompatible blood types. Another problem may be that the donor is not anatomically well suited. This can happen if there is a large size discrepancy between the donor and recipient. For example, a small child who weighs only 20 pounds may not have the space in their abdomen to receive a kidney from their father if he is 6’4” and 250 pounds. In this case, NKR offers a chance to find a suitable donor who may be better size matched.

These are situations when the NKR is an invaluable resource. With high volumes, CHOP is one of only a few pediatric transplant centers in the country involved with the NKR. The registry allows families with living donors who do not match their recipients the opportunity to pair with living donors around the country, increasing access to suitable transplant for multiple patients. So, in the case of the 6’4” dad, he would be listed on the NKR and a better matched donor on the registry would be identified. Sometimes this process involves a direct donor exchange between two families, but often it works more like a domino effect.

Penn Medicine already plays a role in CHOP’s kidney transplant process by evaluating all our potential living donors, since all donors are adults. CHOP and Penn further cooperate for the NKR listings. Drawing on their longstanding relationship with NKR, the Penn team lists the donor on the registry, and if there is an offer, CHOP and Penn review it together and decide whether to proceed.

The NKR gives CHOP’s pediatric patients access to a large pool of potential living donors. As Amaral says:

Knowing that receiving a kidney from a living donor is optimal for long-term health and well-being, particularly for children, our participation in NKR is a big benefit to our patients.

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