Optimal integration of desensitization protocols into kidney paired donation (KPD) programs

Blood type (ABO) incompatibility and antibody to donor human leukocyte antigen (HLA) remain the most significant barriers in transplantation. While pre-transplant desensitization can be administered to overcome such incompatibilities between living donors and their kidney recipients, desensitization alone is likely to fail for those pairs with significant incompatibilities. For these pairs, desensitization can be administered in combination with Kidney Paired Donor (KPD) exchange, the system that allows incompatible pairs to exchange donors with other incompatible pairs to improve donor–recipient compatibilities. Prior operations research literature on KPD investigates the optimal strategy to match donors to patients within a given set of incompatible pairs. However, models and algorithms in these studies exclusively look for the best possible match without considering the possibility of combining KPD and desensitization therapy. The current study adapted the existing models to incorporate desensitization as a way to increase KPD efficiency and embedded it into a simulation framework to evaluate the impact of optimally integrating a desensitization protocol in a KPD program. This is the first attempt to quantify the benefit of such an integration. Our results indicated that desensitization as part of a KPD exchange program is a promising approach to improve access to and to reduce wait time for a living donor renal transplant.