1. Living Donor Options: Paired Kidney Exchange Karen M. Miller, RN, BSN, CCTC October 8, 2011

2.  I have no conflict of interest nor will I be discussing any off-label use of drugs or products

3. Many paired kidney exchanges to choose from  New England Program for Kidney Exchange (NEPKE)  Hopkins group  Alliance for Paired Kidney Exchange  UNOS  University of Michigan Paired Kidney  North Central Donor Exchange Cooperative  MatchingDonors

4. National Kidney Registry  Founder, wife and family (six initial donors) were incompatible with daughter  Entered every paired exchange in the United States  No matches found in paired exchange  There had to be a better solution…

5. Its Success  501 Non profit corporation  Started with $2,500,000 in contributions  First transplants were facilitated in 2/08  Over 40 donor chains have been started to date  349 transplants have been facilitated to date  10 Month Average Wait Time for Match/Xplant  More swaps than any organization in the world

6. Evolution of Paired Exchange Two Pair Exchange Three Pair Exchange Non Directed Altruistic Donor DD RR DDD RRR DR D R D R D R D Cluster #1 Cluster #2 R R R D D Etc. Cluster #3

7. How Has NKR Been Able To Facilitate So Many Paired Exchange Transplants?  Daily Match RunsFaster matching  Real-time 12 deep matching engine… Modeled after NYSE  Web portal for easy pair enrollment …Fast center startup  No personal information required …Avoids HIPAA issues  Automated match offer & tracking…Organized & efficient  Majority of top centers participating…For the greater good  Not controlled by a single center…No conflict of interest  Leveraging the power of donor chains…Open & closed clusters

8. Match Offer Process

9. Speed to Match Estimates based on blood type combinations & recipient PRA RecipientDirect Donor Recipient PRA Score Blood Type < 50%50%-95%> 95% O1 - 2 weeks1 - 4 weeks1 - 6 weeks ABB1 - 3 weeks1 - 6 weeksunknown - Easiest -A1 - 4 weeks1 - 8 weeksunknown ABunknown O1 - 2 weeks1 - 4 weeks1 - 6 weeks AB1 - 3 weeks1 - 6 weeksunknown A1 - 4 weeks1 - 8 weeksunknown ABunknown O1 - 4 weeks1 - 8 weeks1 - 12 weeks BB1 - 6 weeks1 - 12 weeksunknown A1 - 8 weeks1 - 16 weeksunknown ABunknown O1 - 8 weeks1 - 16 weeksunknown OB - Hardest -Aunknown ABunknown

10. Participating Center Fee Schedule  Center start-up & training $4,950/ one-time –Additional cost for non-standard NKR BAA$1,000/ one-time  Database management & technology support –0 transplants facilitated over prior 12 months$100/ month –1 transplant facilitated over prior 12 months $250/ month –2 transplants facilitated over prior 12 months $500/ month –3 transplants facilitated over prior 12 months $750/ month –Additional transplants facilitated prior 12 months$250/ xplant/month  Center annual membership$2,500/ year  Terms –No contract required –Service can be cancelled at any time without penalty

11. Match Offer Email

12. Match Offer Medical Information

13. Match Offer Contacts

14. UW Experience  Joined NKR 12/1/10  Have completed 11 transplants, to date, successfully  Have completed 7 non directed donors (humanitarian)  1 st pair entered 12/6/10  16 link chain  16 donors and 16 recipients  1 st pair completed 2/10/11  UW donor in the OR at 3 am.  UW recipient in the OR at 2pm.  UW donor kidney to UCSF  UW recipient kidney from Pittsburgh  UW donor and recipient (creat 1.4) doing well

15. The Process

26. In Summary  National Kidney Registry has completed the most paired kidney transplants compared to any other paired exchange program  Excellent support  Fast paced/high energy  Have assisted UW in completing 11 more transplants. Eleven patients transplanted that, may, otherwise not have received. Two of those patients highly sensitized.  Have assisted UW in started 7 chains (with non directed donors), which has cumulated in 27, additional, transplants throughout the United States

27. But, it takes a team to make it successful…  Tony D’Alessandro  Luis Fernandez  John Pirsch  Aji Djamali  Transplant surgeons and fellows  Chris Lillesand  Sara O’Loughlin  Elaine Synder and B4/6 staff  HLA staff especially Dave Lorentzen and Katie Meuer  OPO staff especially Mike Anderson  OR team especially Jeff Fenne and Tom Coughlin  Mike Armbrust  Jan Pankow  Kris Patterson  Billing and Fiscal, especially Mary Beth Benson  Data staff, especially Bridget Welch  Transplant Coordinators  Erinn Pullen  Rebecca Hays