The United States and Italy have agreed to establish a pilot program for cross-modality kidney donation. The agreement was signed by the National Transplant Center (CNT), represented by Director Massimo Cardillo, and the Alliance for Paired Kidney Donation (APKD), a nonprofit organization that oversees one of the living kidney transplant programs in the United States. The program is represented by its president, Professor Michael A. Rees, director of the Kidney Transplant Center at the University of Toledo Medical Center in Ohio. Pierpaolo Sileri, undersecretary of health, and Professor Ignazio Marino, executive director of the Jefferson Italy Center - an organization that promotes health collaboration initiatives between Thomas Jefferson University in Philadelphia and Italian institutions - witnessed the signing of the protocol. The new Italy-USA program focuses on so-called "crossover" kidney transplants, in which the donor is genetically incompatible with his recipient but compatible with the recipient of a different couple. Thanks to the agreement between CNT and Apkd, patient couples from Italy and the United States will be able to be crossed based on a shared algorithm that will determine the level of compatibility between the members of the two waiting lists. As a result, patients with chronic renal failure and an unsuitable volunteer donor will have a better chance of receiving a transplant.