BACKGROUND: Live kidney donation represents the gold standard for renal replacement therapy. Due to ABO and HLA incompatibility between donor and recipient pairs, one third of possible transplantations cannot be performed. Kidney exchange programs in combination with extracorporeal desensitization have been introduced to enable successful kidney transplantation in such circumstances. OBJECTIVE: This review discusses the current indications, methods, ethical problems and results within such programs. MATERIALS AND METHODS: Relevant Medline articles were analyzed and personal experiences of the authors are included in this article. RESULTS: Kidney exchange programs in combination with extracorporeal desensitization enable successful transplantation for most patients. DISCUSSION: The best combinations of existing strategies have to be defined and newly arisen ethical questions have to be answered.
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