Awareness and Acceptability of Paired Kidney Exchange Among Highly Sensitized Patients for Kidney Transplant and Their Related Donors

Background: End-stage renal disease remains to be one of the leading causes of mortality worldwide and the gold standard treatment is kidney transplantation. One major limitation is the sensitization to human leukocyte antigen therefore a high number of patients have difficulty finding donors. Paired kidney exchange (PKE) offers highly sensitized patients a chance at survival. There is no local study on PKE among Filipino kidney transplant candidates and their living-related donors. The information generated from this study will be used as a basis for the creation of a donor exchange program that is not only approved by health and judicial authorities but also acceptable to the scientific community and the ultimate stakeholder the Filipino patients. Methods: This is a descriptive cross-sectional design which included 86 donor-recipient pairs undergoing pre kidney transplant workup at NKTI OPD from September to October 2024. Purposive sampling was utilized, and a validated self-administered questionnaire measured the awareness and acceptability levels of the participants towards PKE. Results: Recipients and donors generally expressed good awareness and acceptability of PKE. Out of 86 recipients, nearly all (99%) were aware of PKE but almost half (47.67%) had poor acceptability. Meanwhile, 66% of donors were aware and all (100%) had good acceptability of PKE. Among recipients all were aware about the need of taking higher doses of medications while 99% were aware that risk of rejection is decreased but not eliminated in PKE. Among donors all were aware that they are able to withdraw in the program anytime and 90% were aware of surgical complications that may affect their ability to work. Factors affecting willingness to participate in PKE among recipients and donors were risk of rejection, clinical outcomes and complications, recipient-donor relationships, ethics considerations, and personal conditions prior to donation. Conclusion: PKE offers numerous beneficial advantages for recipients who are highly-sensitized and do not have financial capability to undergo desensitization. Recipient-donor education is vital to provide access to information which consequently encourages well-informed decisions about PKE.