Are there any other options for incompatible donors and recipients?

Incompatible donors who have a positive crossmatch (antibodies in the recipient’s blood that are directed against antigens on the donor’s cells) can undergo special medical treatment to try to remove the donor-specific antibodies from the donor’s blood. This process is called desensitization. The recipient is first treated with medication (intravenous immune globulin) to try to reduce the donor-specific antibodies. After this treatment the crossmatch is repeated. If it becomes negative, the transplant is performed within 3 to 5 days. If it is still positive, the donor can undergo a procedure called plasmapheresis. This is a treatment similar to hemodialysis in that the recipient’s blood is pumped through a filter. In plasmapheresis the filter removes antibodies. After three plasmapheresis treatments the crossmatch is repeated. If it becomes negative, the transplant is performed within 3 to 5 days. If it remains positive, the medication and the plasmapheresis series may be repeated.

Desensitization is reserved for very specific circumstances. Patients who have high levels of antibodies in their blood and have been unable to find a compatible donor may be candidates for desensitization.