Paired pooled donation
Donor and recipient assessment
The donor and recipient must be assessed using a protocol based upon British Transplantation Society / Renal Association guidelines.
It is recommended that the donor and recipient should be assessed and looked after by different clinicians.
If they are found to be biologically incompatible, for example incompatible blood group or a positive crossmatch, then they can be considered for paired / pooled donation. This option should be discussed with the donor and recipient and verbal and written information given outlining the advantages and disadvantages of this approach. A patient information leaflet will be available from NHSBT (ODT).
In addition, the clinician responsible for the donor should ensure that the donor and recipient have been given and has read and understood the HTA leaflet, Information about living-donor transplants (115 Kb).
As part of the counselling it would be appropriate to emphasise that confidentiality of the donor would be respected. However, when such innovative procedures are taking place it is very difficult to avoid press interest (whatever efforts are made to preserve confidentiality) and the donor would need to be warned about that potential.
The HTA and NHSBT have relevant media policies that are continuously under review. General media implications or a specific case can be discussed by contacting the press office of the Human Tissue Authority on 0207 211 3400 or NHSBT on 0117 969 2444.
Donor and recipient registration with UK Transplant
When the clinical evaluations of both donor and recipient are complete, the donor and recipient details must be registered with NHSBT (ODT). This is done using the appropriate forms ('Pooled Donation - Recipient Registration' (KPDR) and 'Pooled Donation - Living Kidney Donor Registration' (K-LIV-PPD), which are available by contacting Data Services on 0117 975 7460. More than one donor may be registered with a potential recipient, subject to each donor's work-up being complete.
Registering a recipient for paired donation does not preclude them from being simultaneously listed for deceased donor transplant.
The matching process
NHSBT (ODT), in conjunction with the University of Glasgow, will carry out 'matching runs' at intervals determined by the rate of registration on to the paired/pooled donation list. Details of the matching process are available in this section.
Download 'The National Matching Scheme for Paired Donation' as a PDF document(79Kb).
Read more about the matching process
Two weeks prior to a run, waiting list reports will be sent to each centre to be checked and any amendments notified to NHSBT (ODT).
NHSBT(ODT) will inform transplant units and the HTA of the results of each matching run and facilitate contact between clinicians responsible for potential paired donations. Transplant arrangements will proceed at the discretion of the clinicians and patients concerned.
A number of 'matching runs' may be required to find a suitable pairing for an individual recipient and their incompatible donor, but it cannot be guaranteed that a suitable compatible pair will ever be found.
Crossmatch tests
Crossmatch tests should be organised between identified potential donors and recipients following the protocol of the implanting unit and laboratory. Both tests should be carried out as soon as practicable and the results reported to NHSBT(ODT). Ideally these tests should be performed and results reported to NHSBT(ODT) within one week of offer.
Suspension of recipients from deceased donor transplant list
If the results of both crossmatch tests show that the transplant can proceed, both recipients will be suspended by NHSBT(ODT) from the deceased donor transplant list. Centres should advise the patients of this change. Any patient who is offered a deceased donor kidney prior to a suitable paired donation being identified should have the option to accept the deceased donor kidney.
Approval process via local Independent Assessor (IA) and HTA panel
A written referral is required from the clinician responsible for the donor to an accredited IA only when a suitable matching pair has been identified. The referral can be written by a living donor coordinator, provided the name of the registered medical practitioner who has explained the procedure and the risks involved is specified.
An example of a referral letter and a checklist of what is required is provided in the HTA document 'Guidance for transplant teams and Independent Assessors'.
The guidance document also provides details of the information that needs to be included in the referral letter.
The written referral should then be sent to the IA with copies of evidence of the relationship between the couple being referred and form HTA IT (DC) where a translator has been used. The referral should also include email contact details of the clinician responsible for the donor and the living donor co-ordinator. This is to ensure that both the donor clinician and living donor coordinator can be informed of the HTA's decision.
Each incompatible donor and recipient couple will be seen together and separately by their local IA. The IA then completes an online report of the interviews and sends it to the HTA. This report contains the IA's recommendation as to whether they believe, based on all of the available evidence, that the donation should proceed. A letter confirming this has been done is sent to the clinician responsible for the donor. Upon submission of the IA's report to the HTA, a reference number is automatically generated and can be used to track the progress of the approval.
A HTA panel will consider the reports of the two couples in each matching pair with the details sent from NHSBT confirming who will be donating to whom. If the HTA panel is in agreement, an approval using the HTA reference number is issued to the IA, NHSBT, the living donor coordinator and the clinician responsible for the donor.
Once HTA approval is obtained, a date for surgery can be agreed. NHSBT(ODT) must be informed of the proposed date. After approval is given, the living donor transplant must go ahead within six months, otherwise a further appointment will be required with an IA for assessment and an updated report from the IA to the HTA will be required.
Transport of kidneys arranged
Transplanting units should liaise in advance with the NHSBT(ODT) Duty Office about arrangements for the operations, so that the Duty Office can organise prompt transfer of donated kidneys to the recipients' transplanting centres as required.
Final crossmatch tests
Units should arrange for final crossmatch tests according to an agreed protocol.
Simultaneous transplant operations
In planning the operation the donor should be asked their wishes should their kidney be removed but not transplanted in the intended recipient for whatever reason.
Retrieval surgery would usually take place in the unit that performed the work-up, with kidneys being transported to the recipient transplant unit for implantation. Alternative arrangements can be made with the agreement of all those concerned. The retrieval surgery for the donors must take place simultaneously, with the clinicians responsible for the induction of anaesthesia in direct telephone contact at that time.
Once the donor and recipient operations have been performed, the clinician responsible for the recipient completes the HTA (B) form, which is sent to NHSBT(ODT), and the transplant team informs the IA.
Anonymity of pairs should be preserved. Post surgery any communication between donors and recipients can be negotiated by recipient coordinators, respecting wishes of both parties, in the way that sometimes occurs between families of deceased donors and organ recipients.
Download 'Arrangements for Paired / Pooled Living Kidney Donation' as a PDF document(35Kb).
