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 . Efforts of European KEPs to exchange (best) practices and share approaches to address challenges have, however, been limited.
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.
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.
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.
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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
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.