BACKGROUND Paired living kidney donation became possible in the United Kingdom in 2006 after the introduction of a new legal framework for organ donation. A national matching scheme was subsequently established and we report the early United Kingdom experience of paired donation. METHODS A new national matching algorithm was developed for the introduction of paired donation in the United Kingdom. Initially, all potential two-way exchanges were identified with prioritization according to a points system based on geographical proximity between pairs, calculated human leukocyte antigen antibody reaction frequency (cRF), HLA mismatch of potential transplant, and donor-donor age difference. Three-way exchanges were additionally considered after the first year. RESULTS The list for paired donation has grown steadily as 3-monthly "matching runs" have been carried out from April 2007, and in July 2008 there were 85 couples registered. Eight paired donor transplants have resulted with a number of identified exchanges unable to proceed. Fewer potential exchanges have been identified than expected due to blood group composition (47 of 85 donors of group A compared with 16 potential recipients [A, AB]) and high levels of cRF (95%-100% in 35% of patients) among listed patients. CONCLUSIONS Paired donation has been introduced successfully in the United Kingdom, adding to living donor transplant activity. The new national program has yielded fewer transplants than initially anticipated but as the scheme evolves, with the use of altruistic, nondirected donors to start a "chain" of transplants, an increase in the number of successful paired donation transplants is anticipated.