The ANZKX program matches incompatible kidney donor and recipient pairs with other incompatible pairs across Australia and New Zealand.
A paired kidney exchange finds matches for people:
- who are eligible for a kidney transplant
- who have a living donor who is willing to donate one of their kidneys but is unable to due to an incompatible blood or tissue type
- whose living donor meets the criteria for kidney donation.
Finding a match
The transplant team enters the incompatible donor and recipient pair’s data into a national database and registers the pair to participate in the program.
The ANZKX clinical team uses a purpose-built computer program to review registered donors and recipients and identify compatible matches.
If a compatible match is identified, then simultaneous transplants can occur by exchanging donated kidneys. This option is known as ‘paired kidney exchange’ or ‘paired kidney donation’.
Compatible pairs and ANZKX
Your transplant team may discuss your entering the ANZKX program even though you are a compatible match. The ANZKX program now has continual matching that allows early identification of potential matches for compatible pairs. If a match is not found promptly for a pair, it might be recommended to proceed with a direct transplant.
Participation in the ANZKX program can be beneficial for compatible pairs by finding a donor who is a better match but is not likely to help if you are already well matched.
Compatible pairs who enter ANZKX can also help others in the program receive a transplant.
Your transplant unit can discuss these options with you if you wish.
The number of patients waiting on dialysis for a kidney transplant in Australia is approximately 1,200 and over 400 in New Zealand.
Altruistic donors are living donors who anonymously donate their kidney with the aim of helping those in need of a kidney transplant. They undergo a rigorous assessment to ensure they are suitable to be a live kidney donor.
An altruistic donor can donate directly to a person on the transplant waitlist, or more commonly through the ANZKX program. This decision can vary according to the state where the altruistic donor lives and the donor’s preference. This will be discussed with your assessing unit.
An altruistic donor can sometimes create a chain that leads to multiple patients receiving a transplant.
Further information about altruistic donation is available on the Living donation webpage and in this Kidney Health Australia factsheet.
Impact of COVID-19 on the ANZKX program
In 2020 at the start of the COVID-19 pandemic, elective surgery including kidney transplants and the ANZKX program was temporarily suspended. As the pandemic evolved, both living kidney donor and deceased donor transplantation resumed.
The ANZKX program has continued to transplant patients and COVID-19 protocols (570KB PDF) have been put in place to reduce risks to patients. This includes screening all donors for COVID-19 prior to surgery to reduce risks of infection.
Detailed information for patients
After a match is made
When an offer is accepted by all pairs in a chain, the matched donors will undergo a blood test to allow a cross-match to be done with their matched recipients. This is to confirm that this pair is compatible and safe to proceed with a transplant.
A CT scan of the donor kidney is also shared with the surgical teams that will be operating on the recipient to ensure the donor kidney is surgically suitable for the matched recipient.
After an offer is accepted
If the cross-match is compatible and surgical review has determined the donor kidney is suitable for the recipient, a transplant date will be set. Your transplant unit will inform you of the date.
The ANZKX team works with all the participating hospitals in the chain to coordinate the operations to occur largely on the same day at the same time. They will facilitate transport of the donated kidneys safely to the recipient’s hospital for transplantation. This allows for all participants to stay in their home state. Occasionally, due to flight path logistics, the start times of the operations may need to be staggered. Your transplant team will discuss this with you.
Preparing for surgery
Within 4 weeks of the surgical date, the recipient's blood will be tested to ensure compatibility with the matched donor. Blood tests are also performed about 9 days prior to surgery to confirm the donor has not acquired any infectious viruses, such as hepatitis B.
Donors and recipients will also need to follow the ANZKX COVID-19 protocols (570KB PDF) including a swab 48 hours prior to surgery.
The recovery process from live donor and transplant recipient surgery is the same. Your doctor will advise the best care method for you.
It is important that all donor and recipient pairs in an ANZKX chain remain anonymous. Donor and recipient pairs must agree that they will not independently engage media in the process.
Example of a paired kidney chain process
In this example:
A and B are husband and wife. B has kidney disease and is in need of a kidney transplant. Donor A is unable to give a kidney to recipient B as they have different blood groups. The transplant team that looks after A and B suggest paired kidney donation.
By entering the patient’s details into the ANZKX program, they can find matches for pairs just like A and B. A match for A and B is found by matching with another pair, where donor C is unable to give to recipient D due to a tissue mismatch. By entering into the ANZKX program, it is found that C is compatible with B at a blood group level, and A with D at a tissue matching level. A 2-way paired kidney chain is created by matching donor C with recipient B, and donor A with recipient D.
The ANZKX program offers the matches to the transplant team looking after B and D. If all agree it is a good match, the next step to organise the ANZKX chain can occur.
About 2-way chains
A 2-way chain is a paired chain where 2 pairs overcome their incompatibility by exchanging with each other. This chain is called a closed loop chain.
A donor and recipient pair (such as A and B shown in this example) must always be in the same chain.
About 3-way chains
A 3-way chain is a chain where 3 pairs overcome their incompatibility by exchanging with each other.
In this example, Donor A gives to recipient F, Donor C to recipient B, Donor E to recipient D.
Chains can also be larger and involve more than 3 pairs.
About non-directed altruistic donor chains
A non-directed altruistic donor is a person who wishes to donate a kidney to someone they do not know (in this example it is donor A).
They may choose to donate through the ANZKX program. When this occurs it allows for longer chains, as there is no need to close a loop. The altruistic donor comes into the chain without a recipient who needs to be matched.
At the end of these chains, the last donor is matched with a recipient on the deceased donor transplant waiting list.
Outcomes of the ANZKX program
ANZKX transplant outcomes are excellent and equivalent to direct living kidney donation outcomes in Australia and New Zealand.