1. Living Donor Paired Exchange
Experience in Canada
November, 2011
David Rush
1

2. PATIENTS DENIED ACCESS TO LIVING DONORS (LD)
HTN
n=18 10%
+XM
n=58 32%
Proteinuria
n=13 7%
Other renal
e.g.
Reasons for LD calculi,GFR
n=9 5%
exclusion (n=180)
Other Medical
n=25 14%
ABO
incompatible
n= 40 22%
Psychosocial
n=17 10%
Martin Karpinski, Leroy Storsley, Greg Knoll, Adam Kohn, Robert Yang, Jennifer Cross, Amit Garg
AJKD

3. CCDT 2005 NATIONAL REGISTRY TASK FORCE
Chairs CCDT
Ed Cole Beverley Curtis
Peter Nickerson David Hollomby
Kimberly Young
John Dosseter
British Colombia Ontario Québec
David Landsberg Carl Cardella Azemi Barama
Maureen Connelly Dana Baran
Alberta
David Holland Lorraine Bell
Patricia Campbell Anthony Jevnikar Isabelle Côté
Jeffrey Zaltzman
Manitoba Nova Scotia
David Rush Bryce Kiberd

4. Math matters…..Optimization Possible matches with
www.OptimizedMatch.com
33 donor-recipient pairs
2 altruistic donors
Requires information technology
to optimize the matches

5. Matching Points
Match Point Attribute Proposed
Per transplant 100
Highly Sensitized (PRA > 80%) 125
ABO Match: O to O 75
Pediatric Recipient 75
Recipient is Prior Living Donor 75
ABDR 0/6 Mismatch 75
Dialysis Wait Time (starting at initiation of dialysis) Days/30
Geography: Same City 25
Donor/Recip Age ∆ ≤30 years 5
ABO Match: A to A, B to B, AB to AB 5
EBV Negative to Negative Match 5
NKRAC Matching Review, October 7/8, 2010 5

6. LDPE Registry Match Cycles
11 Match Cycles completed to date
2009 2010 2011
Jan Feb Mar
Feb May June
May Aug Oct
Oct Nov
Next Match Cycle:
February 13, 2012
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6

7. Assessment and Management
of Immunologic Risk in
Transplantation
A CCDT Consensus Forum
(Montreal 2004)
Knowledge Synthesis and Translation
Clinical Research
Routine Clinical Practice
in all Provinces

8. LDPE … AS OF OCTOBER 31, 2011
11 scheduled match cycles completed
280 donors for 269 registered recipients; 21 first cycle; 125 most recent
0 non-directed donors in first cycle; 25 over next 10 cycles
101 transplants performed (19 to Wait List Recipients)
8 transplants scheduled (2 chains)
27 proposed transplants under review (6 chains)
If all proposed transplants completed then 110/269 = 41%
of registered recipients + 26 waitlist patients transplanted
8 Note: next Match Cycle February 13, 2012

9. POWER OF DOMINO EXCHANGE
Of the 101 transplants completed to date:
12 from Paired Exchanges
64 from Domino Exchanges
25 from N-Way Exchanges
20 dominos of 2 to 5 transplants each
7 chains of 3, 4 or 5 exchanges
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10. REGISTERED RECIPIENTS AGE, GENDER, PRA
Registered Recipients by Age
and Gender
Registered Recipients by PRA
10

11. Registered Donors and
Non-directed Anonymous Donors (NDADs)
Registered Donors by Age and Gender
NDADs by Age and Gender
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12. TRANSPLANTED RECIPIENTS BY PROVINCE
Transplants
Recipient Transplant Program Provincial Totals
Registered Waitlist
Vancouver General 13 3
BC 40 40%
St. Paul’s Hospital 21 3
University of Alberta 4 1
AB 8 8%
Foothills Medical Centre 1 2
St. Paul’s Hospital 4 SK 4 4%
Health Sciences Centre 1 MB 1 1%
London Health Sciences 2
Toronto General Hospital 9 7
St. Michael’s Hospital 12 2 ON 40 40%
The Hospital for Sick Children 1
The Ottawa Hospital 6 1
C.H. Universitaire de Sherbrooke 1
QC 3 3%
Notre Dame 2
Queen Elizabeth II Hospital - NS 2
Atlantic 5 5%
Western Memorial Regional - NL 3
TOTAL 82 19 101 100%
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13. REGISTERED VS. TRANSPLANTED RECIPIENTS
Includes all Registered Recipients and Registry Transplants up to and
including Match Cycle 10
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14. TRANSPLANTED RECIPIENTS
Blood Group # % PRA Percentage # % Months on Dialysis # %
A 34 41% 0% 25 30% 0 30 37%
Transplanted AB 2 2% 1% - 49% 19 23% 1 to 12 16 20%
Registry B 15 18% 50% - 79% 22 27% 13 to 24 14 17%
Recipients O 31 38% ≥ 80% 16 20% 25 to 36 8 10%
Total 82 100% Total 82 100% 37+ 14 17%
Total 82 100%
Blood Group # % PRA Percentage # % Months on Dialysis # %
A 12 63% 0% 15 79% 0 1 5%
Transplanted AB 3 16% 1% - 49% 4 21% 1 to 12 2 11%
Waitlist B 3 16% 50% - 79% 0 0% 13 to 24 1 5%
Recipients ≥ 80%
O 1 5% 0 0% 25 to 36 2 11%
Total 19 100% Total 19 100% 37+ 13 68%
Total 19 100%

15. TRANSPLANTS BY BLOOD GROUP
A to A A to AB AB to AB B to B O to A O to B O to O Total
32 2 3 12 2 3 31 82
39% 2% 4% 15% 2% 4% 38% 100%
PRA of Transplanted
O Recipients # %
0% 7 23%
1% - 49% 7 23%
50% - 79% 8 26%
≥80% 9 29%
Grand Total 31 100%
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16. PROPOSALS VERSUS COMPLETIONS
# of Unique # of Completed
Percent of Proposed
Registrant Proposed Registrant
Matches Completed
Matches Transplants
153 82 54%
# of Proposed # of Completed Percent of Proposed
Chains * Chains Chains Completed
53 33 62%
*Includes all Proposed, Cancelled and Accepted Chains and Paired
Exchanges up to and including Match Cycle 10
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17. REGISTRY OUTCOMES AT 1 MONTH POST-TRANSPLANT
Donor Survival N = 95 100%
Registry Waitlist
Recipients (N=95) Total
Recipients Recipients
Patient Survival 77 100% 18 100% 95 100%
Graft Survival 76 99% 18 100% 94 99%
Rejection episodes 4 5% 2 11% 6 6%
Serum Creatinine
Maximum Minimum Mean Median
254 58 117 103
3 year old child has SCr = 18
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18. NATIONAL ORGAN REGISTRIES
Living Donor Paired Exchange (LDPE)
 Living Donor Paired Exchange creates transplant opportunities for
recipients who have a willing living donor who cannot donate due to blood
type or tissue typing incompatibilities.
National Organ Waitlist (NOW)
 Will replace current national listing maintained by the London Health Sciences Centre. Target
is early 2012.
 NOW will include all status heart, lung, liver, pancreas, small bowel, and multi-organ patients.
Will include recipient HLA
Highly Sensitized Patient (HSP) Registry
 No inter-provincial sharing today for highly sensitized kidney patients. Sharing agreed in
principal. Registry required to make it happen. Targeted for 2012.
 Will include Recipient Listing, Donor Management, Allocation, Offer Management, Inter-
provincial ‘balancing’ and Virtual Crossmatch.
2/3/2012 18

19. Muchas Gracias!
2/3/2012 19

20. TRANSPLANTED RECIPIENTS VERSUS
ACTIVATED REGISTRY RECIPIENTS
Total Registered Total Txd % of Group Txd
Blood Group # % # %
A 68 29% 34 41% 50%
AB 4 2% 2 2% 50%
B 33 14% 15 18% 45%
O 132 56% 31 38% 23%
Total 237 100% 82 100% 35%
Total Registered Total Txd % of Group Txd
PRA Percentage # % # %
0% 45 19% 25 30% 56%
1% - 49% 47 20% 19 23% 40%
50% - 79% 31 13% 22 27% 71%
≥ 80% 114 48% 16 20% 14%
Total 237 100% 82 100% 35%
Total Registered Total Txd % of Group Txd
Months on Dialysis # % # %
0 70 30% 30 37% 43%
1 to 12 48 20% 16 20% 33%
13 to 24 39 16% 14 17% 36%
25 to 36 25 11% 8 10% 32%
37+ 55 23% 14 17% 25%
Total 237 100% 82 100% 35%
Includes all Registered Recipients and Registry Transplants up to and
including Match Cycle 10
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