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Ask the Expert: What is a kidney transplant chain? – The Daily Progress

Q. What is a kidney transplant chain? How do they benefit people in need of a transplant?

A. Transplantation by a live kidney donor offers several advantages to the potential transplant recipient, including better life expectancy, less time on dialysis and better kidney quality.

A substantial number of live kidney donors are incompatible with their intended recipients — such as a family member or friend — either because of blood type differences or the presence of preformed antibodies in the recipient’s body that would be directed against proteins from the donated kidney and cause his or her body to reject the kidney.

Kidney-paired donation (KPD), which can exist in a number of different scenarios, often offers the best option for such incompatible donor-and-recipient pairs. A chain is initiated when a donor from an incompatible pair donates a kidney to the recipient of another incompatible pair. The chain continues when the donor from the second incompatible pair donates a kidney to the recipient of a third incompatible pair and could continue indefinitely.

A chain also can be initiated by an altruistic donor who is not seeking to donate his or her kidney to a particular person. In this case, the chain culminates with what we call a bridge donor, who then can initiate another chain of donations.

KPD via a chain can allow recipients to receive better-matched kidneys, and its greatest benefit is the potential to help multiple people at once by facilitating many transplants. A well-known example of a chain was published in the New England Journal of Medicine in 2009. Ten patients, many of whom would have been very difficult to find matches for because of high antibody levels, were transplanted in less than one year through a chain initiated by an altruistic donor from Michigan.

Dr. Karen M. Warburton is a nephrologist specializing in kidney and pancreas transplantation, including living-donor kidney transplant, for the Charles O. Strickler Transplant Center at University of Virginia Health System. For more information about kidney transplants, visit

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