Duke Health is championing efforts to expand the pool of living organ donors. Two new directors of living donations — Gayle Vranic, MD, for kidney and Matthew Kappus, MD, for liver — join a high-volume transplant program with the multidisciplinary support and clinical expertise to offer comprehensive care to both organ donors and recipients at every stage of treatment.
To increase the number of living organ donations, Kappus and Vranic agree that their success is largely dependent on raising awareness among patients, providers, and the public. Both of their teams have implemented broad education and outreach efforts, with key takeaways:
- For patients: Identifying a living donor may expedite the transplant process and potentially save their lives, so they shouldn’t hesitate to ask friends, family or others to donate regardless of blood type, age or where they live. The donor will receive the same thorough evaluation, expert care, and comprehensive support as the organ recipient.
- For the public: The need for organ donors is great. Even if they are not a good match for a friend or family member in need, they can still donate a kidney or a portion of their liver if they qualify.
- For providers: Consider patients for transplant sooner. “If your patient is suffering, it’s appropriate to think out of the box to get them transplanted,” says Kappus. “At Duke, we want to be a resource to referring providers and figure out a solution together.”
Kidney Partnership Expanding Paired Donor Exchange
Nationwide, living organ donations were trending upward pre-pandemic, reaching an all-time high in 2019 with more than 7,300 living kidney donors. Today, that number is closer to 6,000. “Unfortunately, we have over 100,000 people in this country now waiting for a kidney transplant,” says Vranic. “That’s a huge mismatch in supply and demand.”
To bridge the gap, Duke Health will be working with the National Kidney Registry (NKR), the largest paired donor exchange program worldwide, which has facilitated nearly 8,000 living kidney donor transplants in the U.S.
“We are going to access every resource available through the NKR to help our patients who need kidneys get transplanted,” says Vranic.
As a result of paired donor exchange programs, traditional clinical barriers such as blood type, tissue type, size and age are no longer limitations to living donation because of the larger pool of potential matches accessible through the registry. Geography, too, is no longer a barrier thanks to remote donation. “This allows a donor to donate at a different hospital, sometimes very far away from the recipient,” says Vranic.
Donors also have the option of advanced donation. “This has benefited donors and their recipients tremendously as it allows a friend or loved one to donate in advance, and provide their recipient a voucher to undergo a living donor transplant in the future when they are ready,” says Vranic. “Having these options for donors and recipients has helped expand access to lifesaving living donation.”
Advantages of Living Kidney Donation
Paired donor exchange is especially advantageous for patients who are highly sensitized — those with increased levels of antibodies that make organ rejection more likely and finding an organ match more challenging — as well as minority patients who face racial disparities related to limited access to donated organs.
“One of the most gratifying aspects of using the NKR is that it’s been shown to help people who are on the deceased donor list get access to living donors, which has decreased disparities in living donation for African Americans, women, sensitized patients and patients who are socio-economically disadvantaged,” says Vranic. “Increasing access to living donation for all patients is our top priority at Duke.”
Patients who have a living kidney donor have the ability to be transplanted much sooner than patients on the deceased donor list. These patients spend less time on dialysis and are healthier at the time of transplant. “If a patient is on the organ wait list and they have a person willing to donate a kidney, then they are essentially pulled out of line and can get transplanted more quickly because of the paired donor exchange,” says Vranic.
Living donation offers a longer organ life expectancy compared to getting a deceased donor kidney transplant. “Those kidneys last longer and they work better,” says Vranic. “Recipients have a much better outcome, and they're able to go back and live healthy, more normal lives after transplant.”
To facilitate a solid organ transplant evaluation for your patient, please refer to our transplant referral forms or call 800-249-5864.
Optimizing Process for Living Liver Donation
Patients with end-stage liver disease requiring transplant may not have treatment options to sustain them until an organ becomes available, and nearly 2,000 patients die waiting for a liver transplant annually.
Duke’s transplant program has worked diligently to increase the number of liver transplants over the past decade, pioneering the use of Hepatitis C-positive and Hepatitis B-positive organs. Kappus says the program has also increased donor organs after cardiac death utilizing normothermic machine perfusion to reduce preservation injury before transplantation.
By expanding the pool of viable organs through increased living liver donations, the primary advantage is expediency.
“With the new liver allocation system nationally, it is now becoming a requirement that patients get sicker before they can really have a hope at getting good offers for transplantation,” says Kappus. “So theoretically, patients who have a living donor could be healthier at the time of their transplant, which means a quicker recovery. Also, they may be transplanted for conditions that are not necessarily captured by the MELD [Model for End-Stage Liver Disease] score, such as hepatic encephalopathy.”
One of the challenges of living liver donation is the risk for donors; the surgery is complex, and recovery for a donor can be lengthy. Duke mitigates risk using a highly selective liver donor evaluation that involves a multidisciplinary team of hepatologists, transplant surgeons, and transplant coordinators in the medical and surgical assessment.
Another barrier to living liver donation is the lack of a national registry like the NKD, which limits the potential of non-direct donations. A pilot program [MF1] launched by the United Network for Organ Sharing (UNOS) may make this possible in the future.
In the interim, Duke’s liver transplant program has encouraged non-direct donations by developing their own internal matching system. “We want to be equipped to handle any donor who comes to our program, so we’ve developed our own structured algorithm to match non-direct donors with patients in need, which helps ensure safety and fairness of organ distribution,” says Kappus.