Interprovincial Organ Sharing of Kidneys

Expansion of interprovincial kidney sharing to increase opportunities for pediatric patients, pre-emptive patients and highly sensitized patients with a cPRA of ≥ 99.0% 

Background

Since 2013, highly sensitized kidney patients (HSP) have benefited from the opportunities provided them through the interprovincial sharing of kidneys facilitated through the Canadian Transplant Registry (CTR) and with the collaboration of donation and transplant programs across the country. 

The Kidney Paired Donation (KPD) and Highly Sensitized Patient (HSP) registries identify transplant opportunities for patients who are waiting for a kidney transplant. Despite the success of these registries, a number of transplant candidates remain unable to find a compatible donor.  

Canadian Blood Services continues to work with our advisory committees and provincial partners to evolve national policies to increase transplant opportunities for hard to match patients. 

A national strategy for better HLA-matched transplants for pediatric candidates was first presented at the Canadian Society of Transplantation annual meeting in October 2015. This resulted in an allocation protocol in matching and ranking that prioritizes recipient with 0/6 mismatch at Class II loci DRB, DQA and DQB. Canadian Blood Service’s Kidney Transplant Advisory Committee (KTAC) approved the concept of inclusion of all pediatric candidates in May 2017 and a CST pediatric working group was formed to work through the policy impacts with Canadian Blood Services. KTAC has endorsed, with the recommendation of the CST Pediatric Working Group, that all pediatric patients, whether highly sensitized or not, be listed and eligible for class II 0/6 mismatch offers. 

KTAC has also endorsed that those patients most sensitized (cPRA ≥ 99.5%) should have access to interprovincial sharing regardless of their dialysis status. The National HLA committee (NHLAAC) and KTAC has also endorsed the Willing to Cross Antigens (WTC) policy, for programs to increase the likelihood of the hardest to match patients with a cPRA ≥ 99.0%. 

New Enhancements

With support of our advisory committees and in partnership with provincial programs, Canadian Blood Services is pleased to announce the expansion of interprovincial kidney sharing with enhancements to policies for specific patient groups, aimed at increasing their likelihood of receiving a transplant 

While the current eligibility criteria remain in place for all patients, additional criteria will impact participation for pediatric patients with a cPRA of <94.5% and may enable the participation of pre-emptive patients.  

In addition, the hardest to match patients with a cPRA ≥ 99.0% could potentially gain more access to transplant opportunities through the WTC functionality, by which transplant programs in collaboration with their HLA lab can access WTC through the CTR and adjust a patient’s cPRA by crossing antigens. 

December 4, 2024 Go-Live and Next Steps

On the go-live date of December 4th 2024 a new version of CTR (Version 5.6) will be released with updated IPOS kidney functionalities enabled. 

Training Sessions: Virtual training sessions that are role based specific to ODO Coordinators, Recipient Coordinators, and HLA lab personnel with WTC permissions have been developed to support implementation. These sessions are recorded and can be viewed here. 

CTR access and support: For kidney transplant coordinators or physicians who may need access to CTR , please email the CTR Customer Support team at transplantregistry@blood.ca to arrange for user access and initial user training session. 

Resources and documentation: IPOS Kidney program documents, policies, and training resources in support of our provincial partners can be found here.

Communications: We will continue to work with all stakeholders through multiple lines of communication and various committees to widely communicate and to share all available resources and information pertaining to the IPOS Kidney program. 

Questions: For any questions, please review this FAQ list. If you have unanswered questions, please contact the Canadian Blood Services CTR Customer Support team at transplantregistry@blood.ca.