If the blood types of the donor and the recipient do not match or if the recipient has produced antibodies against the donor (positive cross-matching) a cross-over procedure may be considered. This is also called ‘paired donor exchange‘. The donor of Pair A donates to the recipient of Pair B and the donor of Pair B donates to the recipient of Pair A.
Source: Nederlandse Transplantatie Stichting (Dutch Transplant Foundation)
As soon as the recipient and the donor have been declared medically fit, the treating doctor can register the pair with the Dutch Transplant Foundation in Leiden. All eight kidney transplantation centers in the Netherlands can register patients. Once per quarter the possibilities are checked by means of a computer programme. The exchange can take place between donors-recipients from all eight different centers.
The donor goes to the transplant center of the other pair to donate. The recipient remains in his own center. The operations take place on the same day. Between the pairs there is anonymity, which means that the matching donor and recipient will not see each other. The transplant centers will do their very best to guarantee this anonymity.
The insurance of the original recipient bears all the costs, including the operation and hospital stay of the indirect donor. The contacts with the financial administrations in the hospitals are arranged by the transplant center in question.
After the operation the donor is seen once by the surgeon and the nephrologist in the hospital where the operation was performed. After that, the original center takes over the care of the patient again.
ABO-incompatible kidney transplantation
The first ABO-incompatible kidney transplantation in the Netherlands was performed at the LUMC and by now a lot of experience has been gained. Blood type incompatible means that the blood types don’t match. Mostly the recipient has blood type O and the donor blood type A or B. Someone with blood type O naturally has antibodies against blood type A (anti A) and antibodies against blood type B (anti B).
This combination means that before the transplantation we have to take the antibodies against the donor blood type (blood type A; anti A, blood type B; anti B) from the blood of the recipient. This is done by means of immunoadsorption (type of haemodialysis treatment) of the recipient. As a donor you do not need to undergo special treatment.
After the immunoadsorption treatment we check the remaining quantity of antibodies (‘titre’) against blood type A or B in the recipient by doing a blood test.
If the effect of the above treatment is sufficient, meaning that anti A or B bodies have almost all vanished from the blood of the recipient, the kidney transplantation can take place. If you think you may qualify for this treatment, your transplantation nephrologist could give you more information.