Kidney-paired donation to increase living donor kidney transplantation in India: Guidelines of Indian Society of Organ Transplantation - 2017

• Published in: Indian journal of nephrology 2018-01, Vol.28 (1), p.1-9
• Main Authors: Kute, Vivek, Agarwal, Sanjay, Sahay, Manisha, Kumar, Anant, Rathi, Manish, Prasad, Narayan, Sharma, Rajkumar, Gupta, Krishan, Shroff, Sunil, Saxena, Sandip, Shah, Pankaj, Modi, Pranjal, Billa, Vishwanath, Tripathi, Laxmikant, Raju, Sreebhushan, Bhadauria, Dhamedndra, Jeloka, Tarun, Agarwal, Dhananjai, Krishna, Amresh, Perumalla, Rajshekhar, Jain, Manoj, Guleria, Sandeep, Rees, Michael
• Format: Article
• Language: English
• Subjects: Age differences; Analysis; Complications and side effects; Decision making; Developing countries; Guidelines; Health education; Hospitals; Immunology; Kidney diseases; Kidney transplantation; Kidney transplants; LDCs; Nephrology; Patients; Quality; Special; Success; Surgery; Transplants & implants
• ISSN: 0971-4065; 1998-3662
• DOI: 10.4103/ijn.IJN_365_17

Consent for donor nephrectomy and transplant surgeryRisks and benefits of KPD and non-KPD options (ABOiKT, desensitization therapy, DDKT, and maintenance dialysis)Risks and benefits of kidney donor transport versus kidney transportDRP willingness to travel to other transplant hospitals/stateHospital outcomes of matched candidate's transplantPotential exchange of all medical reports of each other before final allocation and consentPossibility of untoward outcome after surgery or unexpected transmission of infection, disease, or tumor through the donor kidney, even after due precautions have been takenEach high-risk patient with preexisting comorbid conditions such as diabetes, heart disease, and infections should be cognizant of unequal outcome after kidney transplant, which can occur due to patient-related factors.The 2009 KDIGO clinical practice guideline for care of kidney transplant recipients reported that risk factors for acute rejection include the number of HLA mismatches, presence of a DSA, panel reactive antibody test > 0%, and blood group incompatibility (B is the majority agreement).KPD transplant should also be considered among unrelated donors (such as cousins, uncles, and aunts).Since unrelated transplants are allowed as per the law, paired donation among unrelated donors should also be allowedFor KPD transplants, there should be provision of clearance by single authority of the transplant center/state at the same time for all the eligible pairs, instead of collecting clearance from individual states of donors/recipientsAll KPD activities to be directed and supervised by the state authorization committee and the NOTTO and follow their guidelinesNOTTO website should have more detailed information about KPD, ABOiKT, and DDKT, so that patient can make independent decisionAll data of incompatible DRP should flow from the state into NOTTR as mandated under THOA and its rules, in IndiaAll data/registry to be governed by existing law and work within the regulatory framework of NOTTO, regional organ and tissue transplant organization, and state organ and tissue transplant organizationAppropriate government notification or executive orders related to KPD may be issued.First report from India.First report from India.