Abstract: FR-PO0967
Barriers to Expanding Living-Donor Paired Exchange in the United States: Delphi Survey of Operational, Financial, and Ethical Challenges
Session Information
- Transplantation: Clinical - Pretransplantation, Living Donation, and Policies
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Lentine, Krista L., Saint Louis University, St. Louis, Missouri, United States
- Nishio Lucar, Angie G., University of Virginia, Charlottesville, Virginia, United States
- Lee, Brian, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
- McNatt, Gwen Elise, University of Iowa Health Care, Iowa City, Iowa, United States
- Caza, Tiffany, Arkana Laboratories, Little Rock, Arkansas, United States
- Tietjen, Andrea, RWJBarnabas Health, Livingston, New Jersey, United States
Background
Living donor paired exchange (LDPE) is a growing approach to expand access to living donor kidney transplantation and an emerging strategy in living donor liver transplantation. We convened a multidisciplinary workgroup to identify barriers to LDPE expansion in the U.S.
Methods
A Delphi survey was conducted among participants in an American Society of Transplantation Living Donor Community of Practice Controversies Conference (Feb. 2025), including clinicinas, administrators, and patient stakeholders. Subgroups focused on clinical workflow/innovation, finances/operations, ethics/policy, and education/outreach. Barriers were rated on a 1 to 9 Likert scale for importance [mean importance (MI] with standard deviation (SD)].
Results
Participants identified 14 barriers to LDPE expansion (Fig.) including: patient access disparities resulting from variable transplant program LDPE participation [MI 8.2 (SD 1.1)]; financial costs associated with LDPE programs [MI 8.1 (SD 1.1)]; lack of standardized donor protections and cost reimbursement resources across LDPE pathways [MI 8.1 (SD 1.1)]; and variable provision of patient education [MI 7.8 (SD 1.2)]. Additional barriers relate to the need to standardize LDPE education for diverse stakeholders, inconsistent professional training, and concerns for equitable risk assessment.
Conclusion
LDPE has potential to increase access to kidney and liver transplantation, but requires transplant center investment, clinician and staff training, patient education, and supportive policies. The next phase of this Delphi Survey and Controversies Conference report will evaluate strategies to overcome barriers and increase access to LDPE for patients across the U.S. with inferences for global practice.