Table 3.

Proposed interventions for adapting KPD to developing nations

1. Limit length of KPD to 3-way in initial stages to limit complex logistics; after developing comfort with single-center KPD, shift gradually toward multi-center, regional, state, and national programs to expand the donor pool

2. Include non-directed anonymous donors

3. Include biologically compatible pairs

4. Consider avoidance of anonymous donation in early stages to foster trust in the transplant system

5. Employ computer allocation rather than manual allocation to increase match run frequency

6. Start with simultaneous surgery and consider expanding to non-simultaneous surgeries as experience grows

7. Implement robust protocols to protect recipients such as use of deceased donor allocation priority in the case of paired donors refusing to donate after their recipient has been transplanted

8. Adapt strategies for organ shipping versus donor travelling to a transplant center based on regional feasibility

9. Implement surveillance and monitoring from national and international regulatory bodies to prevent illegal organ trafficking during KPD

10. once established, incorporate selected KPD innovations such as donor voucher programs and advanced and/or remote donation