Paired kidney swap overcomes blood group mismatch to save two young patients

When a willing family member cannot donate a kidney because of a blood group mismatch, a transplant may seem out of reach. Kidney-paired donation offers a way around this barrier by allowing two or more donor-recipient pairs to exchange kidneys, enabling patients to receive organs from compatible donors.

A two-way kidney swap between two families has enabled a 15-year-old boy and a 21-year-old man to undergo kidney transplants. Both patients had relatives willing to donate, but blood group incompatibility prevented direct donation. Through the exchange, each patient received a kidney from the other patient's family donor.

The procedure was carried out at Aster CMI Hospital in Bengaluru, using matching software to identify suitable donor-recipient combinations.

Kidney-paired donation, also known as kidney exchange, is an established transplant strategy for patients whose willing donors are incompatible with them because of blood group differences or human leukocyte antigen (HLA) incompatibility. Rather than proceeding with a direct donation, two donor-recipient pairs are matched so that each donor gives a kidney to the other pair's recipient.

In this case, the exchange required extensive planning and coordination, with four operating theatres, four anaesthetists and four transplant surgical teams working simultaneously, supported by infectious disease specialists.

According to Dr Arun Kumar N., senior consultant, nephrology and renal transplant at Aster CMI Hospital, the matching software helped identify appropriate donor-recipient combinations, while coordination across multidisciplinary teams enabled the simultaneous procedures.

The approach can expand the pool of potential living kidney donors by allowing patients to benefit from willing donors who would otherwise be unable to donate directly to them. It also offers an alternative to pursuing other options for overcoming incompatibility, depending on the patient's clinical circumstances.

For patients with end-stage kidney disease, a successful transplant can reduce dependence on dialysis and offer the possibility of a better quality of life. However, outcomes depend on several factors, including donor-recipient compatibility, surgical success, rejection risk and long-term post-transplant care.

The reported milestone highlights how paired donation and technology-assisted matching can help address donor incompatibility, including in paediatric transplantation, where finding a suitable kidney can be particularly challenging.