What question did this study set out to answer?

The aim is to evaluate and propose strategies for enhancing kidney exchange programs and their outcomes.

April 18, 2026Open Access

A Comprehensive Review of Strategies to Advance Kidney Exchange Programs and Optimize Effectiveness and Outcomes

SLStijn C. van de LaarErasmus MC HHHidde A de HeusErasmus MC AWAnnelies E. de WeerdErasmus MC

Key Points

The aim is to evaluate and propose strategies for enhancing kidney exchange programs and their outcomes.
Reviewed national and international kidney exchange programs
Analyzed operational challenges such as cold ischemia time and logistical coordination
Explored innovations in matching algorithms and machine perfusion technologies
Discussed ethical and regulatory considerations
Identified key barriers affecting the effectiveness of kidney exchange programs
Highlighted innovations that can improve donor matching and transplantation processes
Recommended strategic priorities for optimizing equity in future kidney exchange efforts

Abstract

Living donor kidney transplantation (LDKT) offers superior graft survival and costeffectiveness compared to 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 non-simultaneous 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, logistical coordination, algorithmic fairness, 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.

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