The National Kidney Registry: transplant chains--beyond paired kidney donation.

The National Kidney Registry (NKR) has facilitated more than 100 transplants at 24 centers in the past 2 years and the numbers are rapidly increasing. The NKR has inherent capability for rapid change as innovations are developed and incorporated in the approach to matching donors and recipients in transplant chains. Kidneys are shipped with geotracking devices utilizing existing OPO procedures whenever patients are willing to accept them. This reduces the need for donor travel and increases the geographic area where matches can be made. Out-of-sequence transplants can be performed to improve logistics. Matching software is designed to facilitate chain transplantation and incorporates metrics that help transplant centers develop strategies to improve the chances that their patients can be transplanted. Daily match runs and close attention to repairing broken chains have been critical to growing the number of transplants that can be facilitated. A number of new innovations are expected to increase the opportunities for patients and their potential living donors.