1. Paired Kidney Exchange Update October 13, 2012 Karen M. Miller

2. National Kidney Registry Why Does it Work? Over 60 centers have joined 538 transplants to date 308 active donors in the pool Match runs completed daily

3. NEAD DR D R BD R D R D Cluster #1 Cluster #2 R R R D BD Etc. Cluster #3 NDD DR D R R. Simultaneous Domino Paired Donation (DPD) D R D WL Nonsimultaneous Extended Altruistic Donor Chains (NEAD)

4. Children and High PRA (CHIPS) Children--No living donor Adult--WL > 3 years, Highly sensitized, past donor, on dialysis ABO = A, B, AB with greatest chance Max 50 patients

5. Match Offer Process

6. Pair Match Power Pair Match Power is the key to understanding wait time Pair Match Power (PMP) is the most accurate predictor of paired exchange wait time and should be used by patients and clinicians to develop individual matching strategies for pairs

7. How is PMP Calculated?

8. Rule of Thumb If PMP=400+ Pair will match immediately If PMP>200 Pair is easy to match If PMP<100 Pair is hard to match If PMP=0 Pair nearly impossible to match

9. PosD Ctr Donor Alias R Ctr Recipi ent Alias D-ABOR-ABOD-AgeR-Age Recp Avoids PMPCPRA Wait Time Match Points Preselec t Status Target Surgery Date 1PorterAH DBURN0 04 Brigham PA020 666 OO23451653272060Yesn/s 2BrighamJI060776UCLAR4737OO355832659025Yesn/s 3UCLAD4237Jefferson CARO S AA3643 28991625Yesn/s 4JeffersonDIOGSUCSF RE758 B OO44390175020Yesn/s 5UCSFDG759SMadison MCKE W OO60581365941225Yesn/s 6MadisonUNDEJVAHD BKH03 38 OO57550610860Yesn/s 7VAHDJGH8979Stanford SUR20 50 AA562826 972580Yesn/s 8StanfordSUD2052MadisonSTRAROO233565685545Yesn/s 9MadisonLIPPP O 53 Match Acceptance Deadline: 9/10/12 15:00

10. UW Update Joined NKR 12/2010 1 st paired exchange 2/2011 17 transplants in 2011 14 transplants in 2012 (as of 9/24/12) 4 non directed donors in 2012 (9 in 2011) 5 highly sensitized patients transplanted with no desensitization PRA > 85%

11. 18 pairs active 45 CHIP active 6 active chains Two chains with three pairs scheduled

12. In Summary Paired Kidney Exchange works Gives hope to highly sensitized patients Able to use good and willing donors Able to better inform patients r/t PMP Many highs and lows