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One kidney can change many lives—if we let it start a chain. We sit down with Dr. John Friedewald, transplant nephrologist at Northwestern Medicine, to unpack a breakthrough: using a deceased donor kidney to initiate a living donor chain that moves multiple recipients off the waitlist and ultimately delivers a living kidney back to a service member at Walter Reed.

We break down how kidney paired donation works, why non-directed donors supercharge matching, and what changes when a deceased donor becomes the chain starter. Dr. Friedewald explains the military-share pathway, where high-quality deceased kidneys are screened for parity with prospective living donor outcomes, then routed via directed donation to a match in exchange. The recipient’s incompatible living donor pays the gift forward, extending the chain until an unmatched donor returns a living kidney to Walter Reed. Along the way, we dig into logistics, OPO coordination, timing windows, and why this process fits within familiar directed donation workflows.

Fairness and outcomes are front and center. We address concerns about blood type O equity, share early data showing more than double the impact per deceased donor, and discuss how programs monitor blood type flows to avoid disadvantaging anyone on the deceased list. For patients, we explore the real tradeoff between waiting for a theoretical living match versus accepting a filtered, high-quality deceased offer today—especially when months more on dialysis raises risk. With lessons from Italy’s regional rollout and leadership from centers like Northwestern and Michigan, this approach is poised to scale and become a standard tool that magnifies each gift and shortens waits.

Subscribe, share this episode with someone curious about organ donation innovation, and leave a review with your biggest question about deceased donor–initiated chains. Your feedback helps more people find these life-saving ideas.

Links

Northwestern Medicine Transplant

The Alliance for Paired Kidney Donation

Walter Reed Transplant

Military Share Deceased Donor Initiated Chains (American Journal of Transplantation) 

Utilization of Deceased Donor Kidneys to Initiate Living Donor Chains (American Journal of Transplant)

Kidney Paired Donation Chains Initiated by Deceased Donors

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