Domino paired kidney donation: a strategy to make best use of live non-directed donation

A donor and recipient who have incompatible blood groups or HLA sensitivity can be matched with another incompatible pair, to result in two compatible transplants (figure).13-19 Although there are many ways to match up a pool of incompatible pairs, the mathematical technique of optimisation helps to find out which matches will yield the best results.13 Nevertheless, even in paired-donation programmes in which mathematical optimisation is applied, more than 50% of the incompatible pairs in the pool remain unmatched.13,20 In many cases, pools of incompatible donor-recipient pairs have a high proportion of patients with blood types that are hard to match and those with HLA sensitisation. No funding source had a role in study design, data collection, data analysis, data interpretation, writing of the report, or the decision to submit the paper for publication.