What Are Kidney Donor Chains?

Continuing the discussion from Challenge Trials for COVID-19 Trials Beginning:

@sfmatheson, can you tell us about your Kidney Donation Foundation, why you chose to start it, and what your experience was donating a kidney?

I have not mentioned this before, but I’m doing work specifically on kidney transplantation and AI. We good reason to hope that this work will substantially increase the number of transplantable kidneys.

https://ieeexplore.ieee.org/document/8398488

Deep Learning Global Glomerulosclerosis in Transplant Kidney Frozen Sections

Transplantable kidneys are in very limited supply. Accurate viability assessment prior to transplantation could minimize organ discard. Rapid and accurate evaluation of intra-operative donor kidney biopsies is essential for determining which kidneys are eligible for transplantation. The criterion for accepting or rejecting donor kidneys relies heavily on pathologist determination of the percent of glomeruli (determined from a frozen section) that are normal and sclerotic. This percentage is a critical measurement that correlates with transplant outcome. Inter- and intra-observer variability in donor biopsy evaluation is, however, significant. An automated method for determination of percent global glomerulosclerosis could prove useful in decreasing evaluation variability, increasing throughput, and easing the burden on pathologists. Here, we describe the development of a deep learning model that identifies and classifies non-sclerosed and sclerosed glomeruli in whole-slide images of donor kidney frozen section biopsies.

Good news to report too. Our Phase 2 STTR got an impact score of 17 (scores range from the best to worst, 10 to 90), which translates into “we are very likely to get funded.”

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I didn’t start a foundation, and the person involved is a loved one. My loved one was inspired by reading about a living kidney donor chain. There are many of them out there and you can google for them. I’m not comfortable telling my loved one’s story beyond that.

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Donor chains work similarly to paired kidney donations, in that they take advantage of healthy and willing—but incompatible—donors. The chain is initiated by what is called a non-directed donor. A non-directed donor is someone who offers to donate a kidney without a designated recipient, but with the explicit wish to donate to someone in need of a transplant.

Kidneys from non-directed donors are used to initiate a cluster of kidney transplants for incompatible donor/recipient pairs. For each of these clusters – which could potentially include numerous incompatible pairs – there is one potential donor within an incompatible pair who has not donated a kidney but whose partner has received one. This person is called the “bridge donor,” and he or she can be used to initiate yet another cluster of transplants among incompatible donor/recipient pairs.

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Kidney Transplant - Kidney donor chains | Stanford Health Care

I wonder what the typical size of kidney donor chains might be. See this article from 2015:

On March 26, Neyens not only received a new kidney, but she also made history as the final link in the longest kidney-transplant chain ever completed. The chain ended nearly three months after the first recipient in the chain, Peggy Hansmann of Plymouth, Wisconsin, received her new kidney at UW Hospital from a humanitarian donor from Minneapolis.

In total, the chain included 68 people (34 donors and 34 recipients) at 26 hospitals nationwide. UW Hospital had a total of five participants in the chain.

That is really remarkable, and can causally be connected to the generosity of a single individual.

I wonder what this tells us, also, about the psychology of altruism and kinship.

In a paired transplant chain, a humanitarian donor sets off a series of transplants in which family or friends of recipients give a kidney to another person in need — essentially paying donations forward on behalf of a loved one . Because these chains can include many participants, they can be especially helpful to individuals who are highly sensitized (high antibody levels) and as a result cannot find a good donor match. Sixteen of the 35 recipients in this chain were highly sensitized, including Neyens.

My loved one started a chain by donating to a stranger.

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Tell your loved one that they should be very proud of themselves and what they have done.

It also demonstrates the power of a simple idea that can inspire others.

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