J Korean Soc Transplant.  2003 Jun;17(1):69-72.

Donor Exchange (Swap) Program in Renal Transplantation

Affiliations
  • 1Department of Surgery, Yonsei University College of Medicine, Korea. khkwonmark@yumc.yonsei.ac.kr
  • 2Department of Transplant Surgery, Severance Hospital, Seoul, Korea.

Abstract

PURPOSE
Currently, donor supply for transplantation is in serious shortage. In Korea, numbers of patients with end- stage renal failure have been increasing, while patients who could have a graft kidney are limited because of donor organ shortage. To alleviate this problem, donor exchange (Swap) program was launched in Korea. After the success of direct Swap program between two families, we have developed the Swap-around program to expand the donor pool by enrolling close relatives, spouses, friends of potential recipients and motivated voluntary donors. Herein, we report our results of Swap program.
METHODS
Medical records of 918 renal recipients who have undertaken a transplantation surgery between January 1995 to December 2002 in our units, were retrospectively reviewed in terms of donor-recipient relationship and way of donor recruit, episode of acute rejection, and 5-year patient and graft survival.
RESULTS
Transplantation was performed in 90 patients (9.8%) by way of Swap program. The percentage Swap patients among the number of unrelated donor renal transplant has been increasing: 4.2% in 1995, 10.4% in 1997, 40.0% in 2000, 44% in 2002. Five year patient/graft survival rates were 92.1%/90.6% in 90 Swap recipients, which were comparable to 94.3%/90.0% in other kinds of living unrelated recipients (n=240), and 94.5%/90.7% in HLA 1-haplotype mismatched related recipients (n=454). Among the groups, incidence of acute rejection was comparable.
CONCLUSION
We could achieve some success in reducing the organ shortage with Swap program in addition to current unrelated living donor programs without jeopardizing the graft survival. Potentially exchangeable donors should undergo careful and strict medical and social evaluation as a pre-requisite to rule out the commercialism and conserve health of potential donor and recipients. Expanding Swap program to a regional or national pool could be an option to reduce donor organ shortage in the near future.

Keyword

Exchange donor program; Swap

MeSH Terms

Friends
Graft Survival
Humans
Incidence
Kidney
Kidney Transplantation*
Korea
Living Donors
Medical Records
Renal Insufficiency
Retrospective Studies
Spouses
Survival Rate
Tissue Donors*
Transplants
Unrelated Donors
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