1. Poster Title Transplant Professionals' Views on the Participation of Compatible Pairs in Kidney Exchange Programs C. Durand 1, M-C. Fortin 1,2 1. Centre de recherche du Centre hospitalier de l’Université de Montréal (CHUM), Montreal, Canada 2. Nephrology and Transplantation Division, Centre hospitalier de l’Université de Montréal (CHUM), Montreal, Canada BACKGROUND Kidney exchange programs (KEPs):  Make it possible to circumvent incompatibility obstacles (ABO or immunologic incompatibilities);  O blood group recipients are at disadvantage, since they can only receive an organ from O blood group donors (universal donors):  15% chance of a match when a pair consists of an O recipient and a non-O donor cf. 50% chance of a match for a pair with a non-O recipient (1);  KEPs exist in the US, Canada, the Netherlands, South Korea and Romania. Altruistic Unbalanced Paired Kidney Exchange (AUPKE):  Compatible pair consisting of an O donor and non-O recipient is invited to participate in a KEP;  A way to remedy the unfair situation of O recipients in KEPs;  32% of US transplant centres would encourage AUPKE, while 47% would not, because they consider it unethical or not medically necessary. (2) Aim of this study: gather empirical data about transplant professionals’ views on AUPKE. METHODS  Qualitative research  Semi-structured interviews with transplant professionals (nurses, transplant nephrologists, transplant surgeons, transplant coordinators, social workers, etc.) working in four Canadian transplant centres  Qualitative data analysis with the software QSR NVivo (version 9.0) DISCUSSION  AUPKE appeared to be an acceptable option for the Canadian transplant professionals who participated in this study, since it will increase the number of living kidney transplantations performed and will provide more organs for O blood group recipients.  The transplant professionals in this study did not agree on whether AUPKE should be offered under any circumstances or only in certain well- defined situations.  Half of the respondents saw potential benefits (physical or psychological) for compatible pairs that choose to participate in an AUPKE.  Although AUPKE seems to be an acceptable option, respondents anticipated several logistical problems.  Respondents acknowledged the risk of the transplant team putting pressure on compatible pairs to participate in an AUPKE, but also said this would probably not be problematic in reality. Respondents were not interested in alternatives such as a third party or “compatible pair advocate” proposing AUPKE to compatible pairs.  Further studies are needed to look at other stakeholders’ views on AUPKE. REFERENCES 1. Gentry SE, Montgomery RA, Segev DL. Kidney paired donation: fundamentals, limitations, and expansions. Am J Kidney Dis 2011;57(1):144-51. 2. Clark E, Hanto R, Rodrigue JR. Barriers to implementing protocols for kidney paired donation and desensitization: survey of US transplant programs. Progress in Transplantation 2010;20(4):357-65. RESULTS © Durand, Fortin 2012 Printed by CharacteristicsN = 19 (%) Position  Transplant nephrologist  Transplant surgeon  Nurse  Other 5 (26.3) 4 (21.1) 5 (26.3) Gender  Male/Female8 (42.1)/11 (57.9) Age48 (31-65) Number of years of practice19 (2-35) Willing to propose AUPKE to compatible pairs 17 (89.4) RESULTS Table 1: Characteristics of Respondents Table 2: Benefits of AUPKE Social Benefits of AUPKEPersonal Benefits of AUPKE (9/19) Increase the number of renal transplantations performed (19/19):  Increase the number of renal transplantations among O recipients  Increase the number of kidney donors  Increase access to renal transplantation  Reduce the wait list  Reduce costs associated with dialysis Psychological benefits for compatible pairs (6/19) :  Psychological benefits of helping others  AUPKE could bring families of ESRD patients closer  Easier for the patient when there is graft loss, since the donor is a stranger Physical benefits (5/19):  A better kidney for the recipient in the compatible pair  Improved quality of life and health status Table 3: Anticipated Risks of AUPKE Logistical Problems (15/19) Risks for Donors and Recipients in Compatible Pairs (10/19) Risks for Society and the Health Care System (2/19)  Delayed transplantation for the compatible pair  Travel of the compatible pair  More work for the medical team  Break in the chain  Decreased number of living kidney transplantations performed at the centre  Compatible pair’s transplant team has no control over the procurement process; have to trust the system Medical:  Recipient gets a kidney of lesser quality than that of the intended donor Psychological:  Negative impact on the donor and recipient’s relationship  Less attention paid to the donor; the act of donating is underemphasized  Coercion, psychological pressure, both within the pair and from the medical team  Increased costs without corresponding budget increases for transplant centres  Quebec kidneys are sent to other provinces