BACKGROUND: Considerable differences exist among the living donor Kidney Exchange Programmes (KEPs) that are in use and being built in Europe, contributing to a variation in the number of living donor transplants (Newsletter Transplant; International figures on donation and transplantation 2016). Efforts of European KEPs to exchange (best) practices and share approaches to address challenges have, however, been limited. METHODS: Experts from 23 European countries, collaborating on the European Network for Collaboration on Kidney Exchange Programmes Cooperation on Science and Technology Action, developed a questionnaire to collect detailed information on the functioning of all existing KEPs in Europe, as well as their opportunities and challenges. Following a comparative analysis, results were synthesized and interpreted by the same experts. RESULTS: The practices, opportunities and challenges reported by 17 European countries reveal that some of the 10 operating programs are mature, whereas others are in earlier stages of development. Over 1300 transplants were performed through existing KEPs up to the end of 2016, providing approximately 8% of their countries' living kidney donations in 2015. All countries report challenges to either initiating KEPs or increasing volumes. Some challenges are shared, whereas others differ because of differences in context (eg, country size, effectiveness of deceased donor program) and ethical and legal considerations (eg, regarding living donation as such, nonrelated donors, and altruistic donation). Transnational initiatives have started in Central Europe, Scandinavia, and Southern Europe. CONCLUSIONS: Exchange of best practices and shared advancement of national programs to address existing challenges, aided by transnational exchanges, may substantially improve access to the most (cost) effective treatment for the increasing number of patients suffering from kidney disease.

Agence de la Biomedecine Saint Denis France

Department of Computer Science University College Cork Cork Ireland

Department of Economics Lund University Lund Sweden

Department of Nephrology and Renal Transplantation University Hospitals Leuven Belgium

Department of Political and Economic Studies University of Helsinki Helsinki Finland

Division of Nephrology and Dialysis Department of Medicine 3 Medical University of Vienna Vienna Austria

Division of Nephrology and Transplantation Geneva University Hospitals Geneva Switzerland

Dutch Transplantation Foundation Leiden the Netherlands

HEC Management School Université de Liege Liege Belgium

Hellenic Transplant Organization Athens Greece

Institute for Clinical and Experimental Medicine Prague Czech Republic

Institute of Economics Hungarian Academy of Sciences Budapest Hungary

Institute of Mathematics P J Safarik University Košice Slovakia

Instituto Portugues do Sangue e da Transplantacao Lisbon Portugal

Italian National Transplant Centre Rome Italy

Medical University of Warsaw Warsaw Poland

National Health Service Blood and Transplant Bristol United Kingdom

Nephrology Department Laikon Hospital Athens Greece

Organización Nacional de Trasplantes Madrid Spain

Prince Mohammad Bin Salman College King Abdullah Economic City Kingdom of Saudi Arabia

School of Computing Sciences University of Glasgow Glasgow United Kingdom

School of Science and Engineering Reykjavik University Reykjavik Iceland

Transplant Center L Pasteur's University Hospital Košice Slovakia

United Network for Organ Sharing Richmond VA

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