Authors
Vasudevan S, Department of Urology, Medical College, Trivandrum; Kerala Medical Journal
Abstract
Background: Organ transplantation faces a severe demand-supply mismatch globally, particularly in India where annual kidney transplant rates are significantly lower than the need. Traditional live donation is often hampered by donor-recipient incompatibility. This editorial introduces swap donation as a critical solution.
Concept: Kidney Paired Donation (KPD), or swap donation, is an approach to live donor kidney transplantation where patients with incompatible donors swap kidneys to receive a compatible organ. Initially focused on incompatible pairs, KPD has evolved to also include compatible pairs seeking better HLA matching, which is correlated with improved long-term outcomes.
History and Outcomes: KPD was first suggested in 1986, with programs starting in the 1990s. Notable advancements include large swap chains organized in the US. Better HLA matching achieved through KPD leads to longer lasting transplants, lower patient mortality rates, reduced immunosuppression requirements, and facilitates future re-transplantation.
Current Status: KPD is actively utilized in many countries, with advanced donation programs allowing donation for future recipients. In India, over 1000 swap donations have been performed, with significant contributions from institutions like IKDRC and the Apex Swap Transplant Registry (ASTRA). The Kerala government has also issued guidelines facilitating altruistic and swap donations through the Kerala Network for Organ Sharing (KNOS), utilizing computer-assisted matching algorithms. Swap liver transplantation is also being performed.
Conclusion: Swap donation represents a vital advancement in organ transplantation, effectively addressing incompatibilities and improving recipient outcomes by facilitating better-matched organs. Its structured implementation, as seen globally and specifically in India and Kerala, offers significant hope for patients awaiting life-saving transplants.