Strategy 1: Register at transplant center with high volume of cadaveric transplants.If a patient with 80% PRA lists at a transplant center that receives only 20 cadaveric kidneys annually, they get only 2 chances a year that a kidney might be offered: Out of 20 kidneys, half might not match the potential reciepient blood type; leaving just 10, out of those, only 2 might match due to the PRA=80%. If, instead, a candidate lists at a center that gets 120+ cadaveric donors, the chances increase to 12 potential kidney offers a year. Unfortunately, about a quarter of transplant centers in US receive only 25 or less cadaveric kidney in US annually; while another quarter receives only about 50 annually, thus the high PRA patients in those low-volume centers wait very long. The Reduce Wait Time tool has functionality to filter out the transplant centers by volume to determine where the high PRA% folks should be listed to get better chances at transplant. National Kidney Registry has had a stable donor pool of 300+ donors for the last several years. Their matching potential is disclosed in the quarterly report and on average it takes just few months to get transplanted through NKR for a patient with PRA<80%. The 300 donor pool can be viewed as equivalent of being on top of the 3 cadaveric waiting lists with the volume of over 100 transplants each annually.
Strategy 2: DesensitizationWhile majority transplant centers desensitize patients with living donors only, few centers in US are experienced in desensitization of patients on the deceased donor list with absence of the potential living donor: Indiana University, Mount Sinai Hospital in New York City, University of Wisconsin-Madison and University of Washington-Seattle. In addition, a New Jersey medical company, Biologic Tx provides desensitization as an outpatient procedure with no living donor required as well.
Approach 1:The transplant center requires all patients send their monthly blood sample (PRA kit) in, allowing them to run crossmatches for all patients.
Approach 2:Only top 20%-30% who waited the longest are required to send their PRA kits in for crossmatch and considered against the potential donor.