Home News Organ exchange agreement bridges US, Italy for living kidney donors

Organ exchange agreement bridges US, Italy for living kidney donors

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September 13, 2022

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The Alliance for Paired Kidney Donation has launched a pilot program that would allow kidney exchanges for transplantation between the United States and Italy.

The signing of the agreement, between the Alliance for Paired Kidney Donation (APKD) and Centro Nazionali Trapianti (CNT) — the organization which manages all transplantation activity in Italy — allows for the first-ever exchange of living donor kidneys between Europe and the U.S., according to a press release.

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“Kidney exchange helps us celebrate our differences — for the benefits they enable,” Michael A. Rees, MD, PhD, CEO of APKD and surgical director of kidney transplantation at University of Toledo Medical Center in Ohio, said. “Larger pools offer more opportunities for kidney exchange for the incompatible pairs in those pools. But an often-overlooked aspect of kidney exchange is that patients with antibodies that prevent their donors from donating are often produced against targets that are common within their ethnicity or population.

“Kidney exchange shows us how our differences can be the critical component, allowing us to help one another by providing donors that lack the targets of such antibodies,” Rees continued.

Kidney exchange transplantation connects incompatible living donor and recipient pairs with other incompatible pairs for kidney transplants. With the agreement between APKD and CNT, “incompatible American and Italian donor-recipient pairs will be able to exchange with each other based on a shared algorithm that will verify the level of compatibility between those on the countries’ transplant waiting lists,” according to the release. “In this way, patients with kidney failure, who also have an incompatible volunteer donor, will have a greater chance of receiving the transplant they need.”

“We believe the heterogenous U.S. population will allow the homogenous Italian patients a much better chance of finding a match than working with similar populations in Southern Europe,” Rees said.

In addition to the technical-operational aspects — such as the requirements of the participating hospitals, matching algorithm and overall governance of the transplant process — the agreement provides that the costs related to the transplant procedure are borne by the U.S. insurance coverage for the U.S. recipient and the Italian donor, while the Italian National Health Service will cover the expenses for the Italian recipient and the American donor, according to the release. Transplant surgeries will take place in the country where the recipient is located.

“Once the initial operational and management process has been completed, the program will be re-evaluated for possible consolidation of the protocol and the progressive expansion to other living kidney transplant centers of the Italian and APKD networks,” according to the release.

In late 2021, APKD helped coordinate a series of kidney transplants between donors and patients in Israel and the United Arab Emirates.

The kidney exchange program with the APKD is the second international exchange program launched by Italy. Since 2018, Italy has had an agreement involving France, Portugal and Spain, according to the release.

“Living kidney transplants are an effective therapeutic option for recipients and absolutely safe for donors, but to date, they represent less than 17% of kidney transplants performed each year in Italy,” Massimo Cardillo, CNT director, said. “This is a rapidly growing percentage but still insufficient to respond to the many patients still waiting. This agreement between Italy and the U.S. literally opens a new frontier and will allow us to significantly increase the chances of establishing positive matches between different patients.”

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