# Navigating a Quandary in Kidney Exchange Programs: A Review of Donor Travel versus Organ Shipment

## TL;DR

This paper reviews the options of shipping kidneys or having donors travel in kidney exchange programs and suggests that decisions should be based on local conditions to improve participation.

## Contribution

The paper provides a comprehensive review and recommendations for choosing between donor travel and organ shipment in kidney exchange programs.

## Key findings

- Kidneys are typically shipped in most countries, but prolonged cold ischemia time may increase delayed graft function risk.
- Donor travel is emotionally and financially burdensome, leading to reduced willingness to participate in kidney exchange programs.
- Healthcare professionals generally support organ shipment for donors unwilling to travel.

## Abstract

In multicenter kidney exchange programs (KEPs), either the explanted kidney must be shipped, or the donor must travel to the transplanting center. This review describes the available data on these two approaches and formulates recommendations for practice. We searched for studies addressing organ shipment or donor travel in KEPs. Data were categorized into four domains: cold ischemia time (CIT), logistics, donor/recipient perspectives and professional perspectives. From 547 articles screened, 105 were included. Kidneys are shipped in most countries. Prolonged CIT due to shipment may increase the risk of delayed graft function, but does not seem to impact graft survival. Planning the shipment requires a robust logistical framework with guaranteed operating room availability. Donor travel is reported to be both emotionally and financially distressing for donors and exposes them to inconsistencies in donor evaluation and counseling across centers. Reduced willingness to participate in KEP when travelling was reported by 36%–51% of donors. Professionals generally support offering organ shipment to donors not willing to travel. In conclusion, the decision between donor travel or organ shipment should be tailored to local circumstances. Healthcare professionals should prioritize minimizing barriers to KEP participation, either by facilitating organ shipment or reducing the burden of donor travel.