The encyclopedia · R&D & Science · Operational decision · 2004–2006
Netherlands paired incompatible kidney donors nationally and doubled transplants
All seven Dutch transplant centres pooled incompatible donor-recipient pairs; in two years 49% of 146 enrolled couples found a matching exchange.
Dutch Transplant Foundation · Erasmus MC Rotterdam
the move
The Netherlands launched its national living-donor kidney exchange in January 2004, the first national program of its kind, run by the Dutch Transplant Foundation across all seven transplant centres.
From January 2004 to June 2006, 146 donor-recipient couples enrolled and took part in 10 match procedures. A match was found for 72 of the 146 (49%), with significantly better results for positive-crossmatch pairs than ABO-incompatible pairs.
The program combined both types of incompatibility in one pool: nine blood-type-incompatible pairs were matched with nine crossmatch-incompatible pairs, showing how pooling categories raises overall efficiency. The authors concluded the exchange expanded living-donor transplantation successfully.
why it works
- One national pool beats hospital-by-hospital matching because match opportunities grow with pool size.
- Mixing ABO and crossmatch incompatibilities created swaps neither group could form alone.
- Centralised allocation and crossmatching kept the process objective and fair.
- Exchanges turned blocked living donations into actual transplants.
what transfers
When direct exchange fails, build a marketplace for the underlying good: pooling incompatible pairs turns each pair's blocked donation into a tradable unit that can clear someone else's market.
what came after
The Dutch program became the model for national kidney exchange in the UK, Canada and the US. It continues to run, and its registry and match-run data have been studied for two decades as the canonical example of matching-market design in healthcare.
references
- A highly efficient living donor kidney exchange program for both blood type and crossmatch incompatible donor-recipient combinations
- A highly efficient living donor kidney exchange program for both blood type and crossmatch incompatible donor-recipient combinations
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