2026/04/15 by Stijn C. van de Laar, Hidde A de Heus, Annelies E. de Weerd +4 · 1 voice
Medicine · #Acute Kidney Injury Research #Dialysis and Renal Disease Management #Organ Donation and Transplantation
paper · pdf · doi:10.1016/j.ekir.2026.106539
openalex publication_date 2026/04/15 · openalex created_date 2026/04/16 · openalex updated_date 2026/07/23
Living donor kidney transplantation (LDKT) offers superior graft survival and cost-effectiveness compared with deceased donor transplantation (DDKT), yet the availability of immunologically compatible living donors limits its reach. Kidney exchange programs (KEPs) can overcome these barriers by matching incompatible pairs through paired exchanges, domino chains, and nonsimultaneous extended altruistic donor (NEAD) chains. This review summarizes the evolution and current landscape of national and international KEPs. We examine operational challenges (cold ischemia time [CIT], logistical coordination, algorithmic fairness, and ethical and regulatory heterogeneity) and explore innovations in matching algorithms, international kidney exchange debates, and machine perfusion technologies. We conclude by proposing strategic priorities to optimize capacity, equity, and outcomes in future kidney exchange efforts.