Introduction:
The number of living donor kidney transplants performed in India in the year 2022 were 10,164 and deceased donor transplants were 1541. Approximately a third of living donors are rejected due to ABO incompatibility or sensitization. Most of such donors are not transitioning to the paired kidney exchange program. Only 1839 paired kidney transplants have taken place between 2000-2024 from 65 centers. The reasons for this are several, including, an information lack on this option, fragmented distribution of paired exchange programs to isolated institutes across the country, logistic challenges faced by patients to register and endless waiting times.
Methods:
There is a need to build a connected national paired exchange registry, and simplify patient access to this registry by an online, directly patient operated portal. This innovative portal would have a multi-step functionality.
1. Onboarding: where the donor-recipient (D-R) pair directly registers for a paired exchange on the portal tagging their primary Nephrologist along with documentation confirming the identity of these two individuals and their proof of relationship. The Nephrologist would validate this D-R pair following which the portal would validate that registration.
2. Searching: An inbuilt algorithm would match a given D-R pair’s parameters against the available D-R registry and records this in the database with a timestamp. The algorithm generates the best matched pairs and their scores.
3. Matching: The primary Nephrologist of the D-R pair is notified about the available matches and their scores. He accepts the optimal match.
4. Validation: The Nephrologists of each of the two D-R pairs discuss the availability/status/fitness/affordability of their respective D-R pairs and agree to proceed.
5. Approval: The Nephrologist discusses the transplant opportunity with his D-R pair.
6. Preparation: Each Nephrologist liaisons with the transplanting hospital and carries out the medical, psychiatric, legal and statutory documentation and interviews of his D-R pair.
7. Execution: D2R1 gets transplanted at Hospital 1 with Nephrologist 1, and D1R2 gets transplanted at Hospital 2 with Nephrologist 2.
8. Post Execution: The discharged transplant recipients are monitored by their respective Nephrologists.
Results:
The four stakeholders of the portal namely, the Patient, the Nephrologist, the Hospital and the Government, would each have their unique dashboard with defined data access rights. Each stakeholder would be able to monitor the patient’s journey to a kidney transplant. The platform would have the technology to validate the patient by cross checking his documents against the Aadhaar database. The platform will also have an optimising algorithm which ensures the best match to the patient while adhering to the principles of Equity, Cardinality and Utility.
Conclusions:
Paired exchange transplants are fraught with logistic difficulties for patients. Hence this type of transplant remains an unrealised opportunity. This new approach can bring the multiple small, fragmented, paired exchange programs scattered across the country under a single, national, patient operated, simple, technology enabled and algorithm driven platform. This has the capability to significantly increase the number of paired exchange transplants in the country. Entry level barriers to patients and Nephrologists are eliminated by this platform which has the capability to promote and expand the kidney exchange program nationally.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.