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Kidney Week

Abstract: TH-PO1178

Non-Simultaneous Kidney Exchange Cycles in Resource-Restricted Countries Without Nondirected Donation

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical


  • Patel, Himanshu V., IKDRC-ITS, Ahmedabad, India
  • Patel, Ansy Himanshu, BJ Medical College, Ahmedabad, India
  • Kute, Vivek Balkrishna, IKDRC-ITS, Ahmedabad, India

Recent reports suggest that bridge donor renege is rare (1.5%) as part of non-simultaneous kidney exchange chains. In developing countries, surgical space and resources limit the number of simultaneous kidney exchange transplant surgeries.


The aim of this study was to evaluate the bridge donor renege rate during non-simultaneous kidney exchange cycles in a prospective single center cohort study (n=44). We describe the protocol to prepare donor-recipient pairs for non-simultaneous surgeries designed to reduce the renege rate. We propose using standard criteria deceased donor kidneys in the event of a bridge donor renege to protect vulnerable recipients


We report 12 successful non-simultaneous kidney exchange cycles resulting in 44 living donor kidney transplants. These cycles involved 16 bridge donors who were trusted to donate after their incompatible recipient was transplanted, placing 15 recipients at risk (two were at risk from two bridge donors), and no donor reneged. We propose that non-simultaneous kidney exchange cycles could increase living donor kidney transplantation, especially for difficult to match sensitized pairs (17 of 44), in countries with limited transplantation resources


Our study confirms that non-simultaneous kidney exchange cycles can be safely performed with careful patient-donor selection and non-anonymous kidney exchange.