The roles of dominos and nonsimultaneous chains in kidney paired donation

S. E. Gentry, R. A. Montgomery, B. J. Swihart, D. L. Segev

Research output: Contribution to journalArticlepeer-review

74 Scopus citations


Efforts to expand kidney paired donation have included matching nondirected donors (NDDs) to incompatible pairs. In domino paired donation (DPD), an NDD gives to the recipient of an incompatible pair, beginning a string of simultaneous transplants that ends with a living donor giving to a recipient on the deceased donor waitlist. Recently, nonsimultaneous extended altruistic donor (NEAD) chains were introduced. In a NEAD chain, the last donor of the string of transplants initiated by an NDD is reserved to donate at a later time. Our aim was to project the impact of each of these strategies over 2 years of operation for paired donation programs that also allocate a given number of NDDs. Each NDD facilitated an average of 1.99 transplants using DPD versus 1.90 transplants using NEAD chains (p = 0.3), or 1.0 transplants donating directly to the waitlist (p < 0.001). NEAD chains did not yield more transplants compared with simultaneous DPD. Both DPD and NEAD chains relax reciprocality requirements and rebalance the blood-type distribution of donors. Because traditional paired donation will leave many incompatible pairs unmatched, novel approaches like DPD and NEAD chains must be explored if paired donation programs are to help a greater number of people.

Original languageEnglish (US)
Pages (from-to)1330-1336
Number of pages7
JournalAmerican Journal of Transplantation
Issue number6
StatePublished - Jun 2009
Externally publishedYes


  • Blood-type incompatibility
  • Donor exchange
  • Incompatible donors
  • Live donor kidney transplantation
  • Nondirected donors
  • Nonsimultaneous extended altruistic donor chains
  • Paired kidney exchange

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


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