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How Chain
Transplantation Works
T ran s p l a n tA T IO N
Altruistic Donor #1
Incompatible Wife
RECIPIENT #1
Kidney- Transplant Chains
Help to Keep Patients and Hope Alive
Husband DONOR #2
Incompatible Wife
RECIPIENT #2
Husband DONOR #3
Incompatible Wife
RECIPIENT #3
Husband DONOR #4
An innovative program that exchanges the
kidney from an incompatible family member
or friend for a compatible kidney from a
stranger is giving UCLA patients hope of
being freed from the constraints of dialysis.
“It’s a winning situation for everyone,” says
Jeffrey Veale, MD, associate professor of
urology and director of the UCLA Kidney
Exchange Program. “Instead of waiting years
for a deceased donor kidney, patients can
quickly receive a living donor kidney — which
in general lasts twice as long.”
most active chain transplantation center
in the United States, performing 93 chain
transplantations to date. “Besides getting
people transplanted rapidly with the highest-
quality organs, there’s a real humanity
component to this program,” Dr. Veale
says. “It’s beautiful to see people giving and
receiving kidneys from complete strangers.
The recipient usually doesn’t meet the donor
until after the transplantation, and I feel
extremely fortunate to often be the one who
gets to make that initial introduction.”
meant being hospitalized for up to a week;
most of today’s donors leave the hospital the
next day. Similarly, the amount of time donors
would miss work in the past was two to three
months; now it is typically only four to six
weeks. With shorter recovery times for kidney
donors, the relationship to the recipient has
become more elastic. Originally, it was just
family members who were able to donate, but
over the years it has become acceptable for
spouses, friends and now complete strangers
to donate a kidney for transplantation.
A transplant chain begins when an altruistic
donor gives his or her kidney to a recipient
who already has a willing donor but that
donor’s organ is incompatible. That recipient’s
willing but incompatible donor then passes
on the generosity to a different recipient,
whose willing but incompatible donor
does the same, keeping the chain alive.
A specialized computer program run by
the National Kidney Registry matches
donors and recipients across the country.
Dr. Veale was senior author on a recent
article that reported the results of 272 chain
transplantations (the largest study to date).
Approximately 50 percent of the chain
recipients were female and 46 percent were
ethnic minorities — two groups that have
historically had a difficult time finding
matches due to their naturally elevated
antibody levels.
In 2011, a chain intertwined the lives of
60 strangers and involved the donation of
30 kidneys across the country; UCLA
handled 16 of the patients, the largest number
of any participating hospital. “The chain
transplantation program is truly remarkable,
as it enables us to take the gift from a single
altruistic donor and amplify it dozens of
times,” Dr. Veale says.
UCLA has one of the world’s highest-volume
kidney-transplantation programs and is the
UCLAHEALTH.ORG 1-800-UCLA-MD1 (1-800-825-2631)
One of the factors driving the growth of chains
is that donor surgery now is being performed
laparoscopically, which is less invasive than an
open surgery. In the past, donating a kidney
For more information about the UCLA
Kidney Exchange Program, go to:
transplants.ucla.edu/kidneyexchange