• While providing a new lease of life to 4 patients and their families, the procedure also provides a solution to a critical problem of shortage of compatible kidneys that can be used for patients suffering from kidney failures in India.
• According to recent reports, India’s annual requirement for kidney transplant could range between 1-2 lakh, with a mere 5000 occurring in reality. As per Kerala Network for Organ Sharing (KNOS) there are 1780 patients waiting for a kidney transplant in the State.
In a novel procedure that connected 4 patients requiring kidney transplant with four kind donors, through cross-matching as per compatibility, helped save 4 lives at Aster MIMS Hospital- Calicut, the second time that such a complex procedure has been performed at a single medical facility in India. The Renal Transplant Team who performed the 8 surgeries successfully, following all the additional medical protocols set-up during the current COVID-19 pandemic to ensure that the recipients and the donors recover successfully, has received a special commendation from the Honourable Health Minister of Kerala, Smt. KK Shailaja.The 4-way swap transplant procedure opens doors to an effective solution to save lives from end-stage renal failure, which in many cases is caused by chronic kidney disease that accounts for 1.36 lakh adult deaths in India every year. [3]
The process started when two female sensitized re-transplant patients presented at the hospital with healthy donors. Both the donors had O+ blood group which made them universal donors. After several sessions of cross matching spread over 6 months compatible donors where identified for the two female patients and one recipient- donor pair volunteered to facilitate the process. During the process an ABO incompatible pair was converted to ABO compatible through which the transplant team could facilitate the fourth transplant.
Commenting on the procedure Dr.Sajith Narayanan, Senior Consultant, Nephrology Department said, “The success of the swap transplant depended on the mutual respect and the trust factor between the nephrologists and the patients. In this case, we really respected the faith that these patients, the donors and their respective families had put on us which further enabled us to effectively navigate through the complexities and perform all the 8 surgeries successfully.”
After immunological profiling by transplant immunology lab and nephrology team, all patient – donor pairs underwent individual and group counselling. Aster MIMS Hospital’s ethical committee reviewed all the details and the transplant team conducted all the assessments, prepared the surgical plan, basis which State’s Zonal transplant Authorization committee approval was secured.Post this, the hospital management worked out and took care of the transplant day logistics.
The four donors and recipients were admitted a day in advance, COVID 19 tests were conducted and they were taken up for transplant on next-day morning. Two transplant were completed on the same day and the other two on the very next day. All donor and recipient surgeries were uneventful with no complications. All four recipients exhibited prompt urine output.
Prior to this, Aster MIMS Calicut Hospital had performed a 3-way swap kidney transplant, setting a milestone in the history of kidney transplants in the State of Kerala. The four-way swap transplant sets a benchmark in India by providing an effective and practical solution for patients awaiting organ donations.