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April 29, 2026
Precision matching in kidney transplant: what experts say about benefits and risks
Kidney transplantation is often the best treatment option for people facing kidney failure. However, even after a successful transplant, about half of recipients of kidneys from deceased donors develop antibodies that can lead to organ rejection over time.
To reduce this risk, researchers have been exploring more detailed ways of matching donors and recipients. One approach is called molecular matching of Human Leukocyte Antigens (HLA)—proteins found on the surface of cells that play a key role in how the immune system recognizes what belongs in the body and what does not. More precise HLA matching could, in theory, improve compatibility between donor kidneys and recipients and reduce the risk of rejection.
In this study, Montreal-based researcher Lucy An and colleagues interviewed seven HLA experts across Canada to understand their views on whether molecular matching should be used in allocating kidneys from deceased donors.
The experts agreed that more precise molecular matching could potentially reduce the risk of organ rejection. However, they cautioned that the benefits have not yet been clearly proven or measured at a population level.
They also highlighted practical challenges. Molecular matching would likely require additional testing, equipment, specialized staff, and time, which could increase costs and complexity in the transplant system.
Importantly, the experts raised concerns about fairness. They noted that if kidneys are reserved for more closely matched recipients, it could increase wait times for some patients. It could also worsen existing inequities, particularly for people from non-white ethnic backgrounds, who may already have a smaller pool of potential donors with similar HLA types.
To address these concerns, the experts suggested that if molecular matching is adopted, it should include safeguards—such as setting a maximum waiting time for a closely matched kidney—to help balance improved outcomes with equitable access.
