The Canadian kidney transplant system has traditionally relied on list-based and geographic criteria to allocate organs, despite compelling evidence that genetic human leukocyte antigen (HLA) matching between donors and recipients can significantly reduce transplant rejection. HLAs are proteins on the surface of most cells that help the immune system distinguish the body's own cells from foreign cells that may be a risk.  This project tackled the technical, practical and social challenges of implementing an HLA-based matching system and developed innovative tools for post-transplant immune monitoring. 

The project team determined population frequencies of HLA epitopes across 11 genes, confirming that epitope matching within Canadian populations is feasible. New genomic techniques for donor and recipient epitope typing were established and implemented across all 14 HLA labs in Canada.  Simulations of compatibility strategies helped to identify optimal matching approaches. Public engagement through deliberative dialogue sessions helped shape equitable allocation policies, while economic and pharmacological models supported personalized immune suppression strategies. Web based tools were also developed to assess the feasibility and fairness of epitope-compatible transplants.  Cumulatively, this led to policy changes in the national transplant allocation system and the launch of the “Willingness to Cross” program, which has already facilitated kidney transplants for highly sensitized patients.  

Overall, the project set new benchmarks in personalized medicine, immune monitoring, and rapid HLA typing. It enhanced clinical readiness and donor-recipient compatibility, while prioritizing equitable access to transplantation. These advancements have significantly improved transplant outcomes and contributed to long term health equity for Canadians, with implications for the global transplant community.  A follow on project led by the same team has been funded by Genome BC and Genome Canada, in partnership with Canadian Blood Services, to allocate kidneys to patients across Canada using the molecular matching techniques developed in this project to reduce the risk of organ rejection.