Implementation of a Canadian willingness to cross program: A strategy to increase access to kidney transplantation for highly sensitized patients

More than 20 percent of candidates on the kidney transplant waitlist are considered difficult-to-match for the already scarce resource of kidne y organs. This is because their immune system has previously been activated through pregnancy, blood transfusion, or prior organ transplants to produce a broad range of antibodies that limit their chances of finding compatible donors. These "highly sensitized" patients (HSP) face prolonged wait-times, reduced access to transplant, and an increased risk of death on the waitlist. The main objective of this research is to implement a first-of-its-kind Willing to Cross (WTC) program. Under this national initiative, patients will be able to be transplanted across known antibodies against donors that are deemed to be at low risk of causing rejection. This strategy is anticipated to improve the chances of receiving a transplant while maintaining good patient outcomes. In addition, the study will follow patients with two cutting-edge immune assays that have been shown to detect rejection before kidney injury occurs. Recognizing that we serve a diverse patient community with different values and beliefs, we will also evaluate patient perception and readiness to adopt this new kidney allocation system.