A swap kidney transplant attempt is set to become the city’s first such effort in a public hospital where a woman will donate one kidney to a man, and the latter’s father will donate his kidney to her husband. The live swap is expected to be conducted in May this year.
The transplant, which obtained necessary approvals from Directorate of Medical Education and Research (DMER) earlier this month, will be conducted at the civic-run King Edward Memorial Hospital.
This is the first such transplant at a government hospital in the city after the 2011 amendment in the Transplantation of Human Organs Act. According to the amended law, an unrelated donor could donate his or her kidney to a recipient whose family member would in return donate one kidney to another patient. This method is successful for those whose blood group does not match within the family and require kidney donation from a stranger.
A Mumbai-based man, with A-positive blood group, has been on dialysis for over three years for kidney treatment. Another patient was put on dialysis three months ago in KEM hospital. “Their cots were adjacent to each other. That is when we realised we could arrange a swap,” said Dr N K Hase, nephrology head at KEM hospital.
Data available with the Apex Swap Transplant Registry (ASTR) shows that since 2011, 40 kidney swap transplants have been conducted in Mumbai. The ASTR maintains a waiting list of chronic kidney patients who require live donation. The current list has 249 patients in waiting.
The names of donors and recipients have been withheld until the transplant surgery. Doctors at KEM conducted compatibility test and Human Leukocyte Antigen (HLA) test on the man, his wife (who is B positive) and on second patient (also B positive) and his father (an A positive blood group). HLA is test to ensure whether the donor and receiver’s immune system has similar antigen structure. Antigens, in immune system, help fight infection through antibodies.
“The blood groups were compatible for swap, only the HLA does not match,” Hase added.
In case the HLA does not match, the recipient’s antigens can reject the donor’s kidney. In this case, the recipient will be administered with immuno-suppressors to avoid any antigen-specific immunity.
Since 1998 till now, KEM hospital has conducted 670 live single kidney transplants and 22 cadaveric kidney transplants.
ASTR’s co-ordinator Dr Ganesh Sanap, however, said awareness on kidney swaps is still low in India. “Several nephrologists do not know that a registry to match unrelated donors and recipients exists. Patients have to wait for months to get a suitable donor. If cadaver donations increase, the need for live donations may not even be required,” Sanap told Newsline.
Dr Kempi Patil, assistant director at the state’s Directorate of Health Services, said, “The cost involved in transplants is huge and private hospitals are willing to participate in such procedures. But we have seen almost negligible participation from government hospital in organ transplants because they receive patients from weaker economic backgrounds.”
Anirudh Kulkarni, transplant coordinator at Jupiter Hospital, which is registered for cadaver kidney and liver transplants with Zonal Transplant Coordination Center, said, “The transplant count in government hospitals is low. But we should also note the bureaucratic delay. The DMER’s paper work is tedious and often approvals take long. Maybe if that is improved, more hospitals will participate in swap and cadaver transplants.”