Market design in New Zealand

Via Al Roth's great (US) blog Market Design, I leant about a New Zealand example of market design. A kidney exchange has got going in New Zealand. Some information from Kidney Health New Zealand

New Zealand Paired Kidney Exchange Scheme – Information Sheet June 2009

1. Introduction

1. This information sheet is designed to provide basic information regarding the NZ Paired Kidney Exchange (PKE) Scheme.
2. Detailed information regarding kidney transplantation and live donor nephrectomy (kidney removal) will be supplied to you by your transplant co-ordinator. You should make sure that you have received this information and that you understand the operations and any medicines that you will need to take. The exact protocols for transplant and nephrectomy vary slightly between the 3 NZ transplant units.
3. Any questions should first be directed to your local transplant co-ordinator or renal specialist, if they are unable to assist then you should contact the Medical Director of the NZ Kidney Allocation Scheme – Dr Ian Dittmer. Your co-ordinator will be able to put you in contact.

2. Purpose

1. Kidney transplant is usually the best treatment for people with end stage kidney disease, however waiting times for a deceased donor kidney transplant are very long.
2. Live kidney donation has therefore become one of the treatment routes of choice. Unfortunately some donor / recipient (D/R) pairs cannot proceed because of
        i .  A positive crossmatch caused by anti-HLA antibodies
        ii.  Incompatible blood groups
3. The PKE scheme is designed to allow D/R pairs who are unable to proceed to transplant as described above an opportunity to do so.
4. The simplest example of how this might work is
   i. Donor X – blood group A, recipient X blood group B.
   ii. Donor Y – blood group B, recipient Y blood group A.
   iii. These two pairs cannot proceed normally but with PKE donor Y can give a kidney to recipient X, and donor X to recipient Y
   iv. Importantly these 2 transplants can proceed without any extra immunosuppressive medication.

3. How the PKE scheme works

1. D/R pairs who wish to participate in the scheme will have their Blood Group and Tissue Typing details entered into a database. This information will be held in the NZ Blood Service Tissue Typing Lab in Auckland.
2. Prior to being formally entered the D/R pair will need to have
   i. Been accepted both as suitable for transplantation and for donation. The NZ transplant subcommittee has agreed to guidelines for assessing this.
   ii. Completed all their work-up for these procedures.
   iii. Given written consent to enter the PKE scheme.
3. At least every 2 months a search will be made of those enrolled in the scheme to see if there are any possible paired exchanges.
   i. Priority will be given to those waiting on the National Kidney allocation scheme the longest.
   ii. There will be a small extra priority given to children as in the deceased donor scheme.
4. Where a possible PKE match is found then both pairs will be notified and planning begun for the transplants if both pairs still wish to participate.

Crossmatches will be performed to confirm that both transplant procedures are safe to perform.

4. How the transplants will be performed

1. The donor nephrectomies will be performed at the same time
2. The transplants will be performed as soon after the nephrectomy as is practically possible – these may not be at the same time exactly but any difference will not be enough to have an effect on transplant function
3. The operations may not all be performed at the same transplant centre, in fact they will often be performed in different centres.
   i. Where a kidney needs to be transported this will be co-ordinated by Organ Donation NZ

5. Other important information

1. You will not be given any information regarding the D/R pair who you are exchanging kidneys with
   i. All D/R pairs will be medically acceptable for the procedures
   ii. The kidney you will receive has been assessed as having good function
   iii. The recipient that will receive your kidney has been assessed as having a good chance of successful transplantation
   1. if there is any variation from this you would be informed
2. The success of the transplant is not guaranteed
   i. outcomes should be the same as normal live donor transplants and unfortunately this means that 1 in 20 of the transplants will fail in the first 12 months
   ii. in the unfortunate situation where a transplant fails without ever functioning then the recipient of that transplant will keep all their waiting time points
3. PKE transplants may be difficult to arrange
   i. We will try very hard to make sure that everything proceeds smoothly
   ii. We will try to ensure that the date you have been given for the transplant is kept to, but cannot guarantee this even the evening before the transplant
   
4. There is no guarantee that we will find you a suitable D/R pair for you to participate in a PKE with
   i. We expect however that we will be able to perform at least 2 PKEs each year – a significant increase in the number of live donor transplants performed.
   ii. We hope for more
   iii. We will try to provide regular updates as to the number of D/R pairs in the scheme