Modern approaches to incompatible kidney transplantation

Figure 3 Paired kidney exchange paradigms. Traditional exchange: This exchange swaps two ABO incompatible pairs so that new donor recipient pairs are now ABO compatible. Non-traditional exchange: This exchange uses one human-leukocyte antigen (HLA) incompatible pair and one ABO incompatible pair and trades for two HLA compatible and ABO compatible transplants. Domino chain: This chain starts with a non-directed donor. The recipient of this kidney then has their donor available for another recipient. This occurs progressively until a donor cannot be matched. This donor can act as a bridge to a new chain or can donate to the deceased donor waiting list, thereby ending the chain.