Global Nephrology: Kidney Donor Networks in the US

An article by Kevin Sack in the New York Times on February 18 very nicely demonstrates the power of organized networks in increasing kidney donation rates. In the article, Mr. Sack describes how chain 124, a kidney donor network, resulted in 30 kidney donations across the United States.

The article highights the work of Garet Hil, a Long Island NY businessman, who is the founder of a non-profit agency called the National Kidney Registry (NKR). This effort had it’s beginnings in 2008; Mr Gil is quoted in the article as saying: “The goal was very simple: get everybody transplanted in under six months if you had a living donor.”

Fig.1" Transplants facilitated by NKR
(Source: NKR Web site)

Briefly described, the disruptive innovation underlying NKR is a computer program that matches kidneys across states and hospitals in the US. In the past 3 years, the donation of 407 kidneys have been transacted through NKR (Fig. 1). And, most importantly, the wait time is down to less than one year (Fig. 2).

Sack writes: “Domino chains, which were first attempted in 2005 at Johns Hopkins, seek to increase the number of people who can be helped by living donors. In 2010, chains and other forms of paired exchanges resulted in 429 transplants. Computer models suggest that an additional 2,000 to 4,000 transplants could be achieved each year if Americans knew more about such programs and if there were a nationwide pool of all eligible donors and recipients.”

“Mr. Hil seized on the idea and set out to build an algorithm that would enable even more transplants. Nowadays, his pool typically consists of 200 to 350 donor-recipient pairs. That is enough to generate roughly a googol — 10 to the 100th power — of possible chains of up to 20 transplants if all of the pairs are compatible, said Rich Marta, the registry’s senior software designer.

Fig. 2 (Source NKR Web-site)

The program quickly eliminates matches that will not work because of incompatible blood types or antibodies, or because a transplant candidate insists that a donor be under a certain age or a close immunological match. It then assembles up to a million viable combinations at a rate of 8,000 per second.”

The computer program then matches by HLA antigens and then an algorithm provides a ranking of possible combinations based on patient’s with hard-to-match kidneys and the length of time a patient has been on a waiting list.

The algorithm ranks the possible combinations by the number of transplants they would enable, with weight given to chains that find kidneys for hard-to-match patients and those who have waited a long time.”

The bottom line: NKR exemplifies the disruptive innovation that could make changes in the care of kidney patients. Garet Hil, NKR's founder, shows that a good idea, well executed, can make a difference.