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Building Kidney Exchange Programmes in Europe – An Overview of Exchange Practice and Activities

Biró, Péter1; Haase-Kromwijk, Bernadette2; Andersson, Tommy3; Ásgeirsson, Eyjólfur Ingi4; Baltesová, Tatiana5; Boletis, Ioannis6; Bolotinha, Catarina7; Bond, Gregor8; Böhmig, Georg8; Burnapp, Lisa9; Cechlárová, Katarína10; Di Ciaccio, Paola11; Fronek, Jiri12; Hadaya, Karine13; Hemke, Aline2; Jacquelinet, Christian14; Johnson, Rachel9; Kieszek, Rafal15; Kuypers, Dirk16; Leishman, Ruthanne17; Macher, Marie-Alice14; Manlove, David18; Menoudakou, Georgia19; Salonen, Mikko20; Smeulders, Bart21; Sparacino, Vito11; Spieksma, Frits16; de la Oliva Valentín Muñoz, María22; Wilson, Nic23; vd Klundert, Joris24 on behalf of the ENCKEP COST Action

doi: 10.1097/TP.0000000000002432
Original Clinical Science—General: PDF Only

Background Considerable differences exist among the living donor Kidney Exchange Programmes (KEPs) that are in use and being built in Europe, contributing to a variation in the number of living donor transplants [6]. Efforts of European KEPs to exchange (best) practices and share approaches to address challenges have, however, been limited.

Methods Experts from 23 European countries, collaborating on the ENCKEP COST Action, developed a questionnaire to collect detailed information on the functioning of all existing KEPs in Europe, as well as their opportunities and challenges. Following a comparative analysis, results were synthesised and interpreted by the same experts.

Results The practices, opportunities and challenges reported by 17 European countries reveal that some of the 10 operating programmes are mature, while others are in earlier stages of development. Over 1300 transplants were performed through existing KEPs up to the end of 2016, providing approximately 8% of their countries’ living kidney donations in 2015. All countries report challenges to either initiating KEPs or increasing volumes. Some challenges are shared, whilst others differ because of differences in context (eg, country size, effectiveness of deceased donor programme) and ethical and legal considerations (eg, regarding living donation as such, nonrelated donors, and altruistic donation). Transnational initiatives have started in Central Europe, Scandinavia, and Southern Europe.

Conclusions Exchange of best practices and shared advancement of national programmes to address existing challenges, aided by transnational exchanges, may substantially improve access to the most (cost) effective treatment for the increasing number of patients suffering from kidney disease.

This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1Institute of Economics, Hungarian Academy of Sciences, Budapest, Hungary

2Dutch Transplantation Foundation, Leiden, The Netherlands

3Department of Economics, Lund University, Lund, Sweden

4School of Science and Engineering, Reykjavik University, Reykjavik, Iceland

5Transplant Center, L. Pasteur's University Hospital, Košice, Slovakia

6Nephrology Department, Laikon Hospital, Athens, Greece

7Instituto Portugues do Sangue e da Transplantacao, Lisbon, Portugal

8Medical University Vienna, Vienna, Austria

9National Health Service Blood and Transplant, Bristol, United Kingdom

10Institute of Mathematics, P.J. Safarik University, Košice, Slovakia

11Italian National Transplant Centre (CNT), Rome, Italy

12Institute for Clinical and Experimental Medicine, Prague, Czech Republic

13Geneva University Hospitals, Geneva, Switzerland

14Agence de la Biomedecine, Saint-Denis, France

15Medical University of Warsaw, Warsaw, Poland

16KU Leuven, Leuven, Belgium

17United Network for Organ Sharing (UNOS), Richmond, USA

18School of Computing Sciences, University of Glasgow, Glasgow, United Kingdom

19Hellenic Transplant Organization, Athens, Greece

20Department of Political and Economic Studies, University of Helsinki, Helsinki, Finland

21HEC Management School, Université de Liege, Liege, Belgium

22Organización Nacional de Trasplantes (ONT), Madrid, Spain

23Department of Computer Science, University College Cork, Cork, Ireland

24Prince Mohammad Bin Salman College, King Abdullah Economic City, Kingdom of Saudi Arabia

*contributed equally


PB, BH and JvK organised the survey and research. The 2 first authors have contributed equally as regards design, analyses of the study and writing the manuscript as the chair and vice-chair of Working Group 1 of the ENCKEP COST Action. DM, JvK contributed significantly in writing the paper while JvK was chair of the COST Action. LB and RJ contributed to the questionnaire design. All the remaining authors have provided information in the questionnaires on their countries of origin, also including LB, BH, AH and RJ. Finally, TA, CB, GB, KC, PDC, JF, BH, KH, RJ, RK, RL, M-AM, GM, BS and MV gave presentations about their national KEPs, and everyone participated in the discussions at the ENCKEP workshops.


The authors declare no conflicts of interest.

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