|LETTER TO EDITOR
|Year : 2021 | Volume
| Issue : 4 | Page : 388-389
Will the living donor liver and kidney exchange program succeed?
Vivek B Kute, Hari Shankar Meshram
Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
|Date of Submission||16-Feb-2021|
|Date of Decision||16-Jun-2021|
|Date of Acceptance||01-Sep-2021|
|Date of Web Publication||30-Dec-2021|
Dr. Hari Shankar Meshram
Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kute VB, Meshram HS. Will the living donor liver and kidney exchange program succeed?. Indian J Transplant 2021;15:388-9
Samstein et al. reported an innovative proposal of living donor liver–kidney exchange program (LDLKEP) that seeks to address the universal problem of the organ crisis. Worldwide, there is a disparity in an access and outcome to renal replacement therapy. LDLKEP will be more helpful for patients in developing world, given the premise that a deceased donor kidney transplant program has not been widely established, 90% kidney donations are from living donors and the morbidity, and mortality of long-term dialysis is very high due to financial crisis and disparity in access to renal replacement therapy [Table 1].,,
| No Legal Restriction|| |
Cases of swap donation referred to under subsection (3A) of section 9 of the Transplant of Human Organs Act India 2011 approved that the donation of organs shall be permissible only from near relatives of the swap recipients. Thus, it allows human organs paired exchange and does not specify that organs must be same. Thus, there is no legal restriction for LDLKEP in India and United States.,
| Transorgan exchange Willingness from Developing World|| |
In a study of 20 difficult-to-match (waited for 12 months in living kidney donor exchange program) incompatible donor recipient pairs (DRPs), 80% of potential donors were willing to participate in LDLKEP to provide gift of life to their family members. In a study of 20 transplant physician, 70% were willing to participate in LDLKEP in an experienced center when morbidity and mortality of transorgan exchange is similar. More studies are required about willingness to participate in transorgan exchange.
| The Way Forward|| |
LDLKEP is not a reality yet. The magnitudes of complications for liver donors are greater than the kidney donors. However, to overcome the harms and inequity in this proposal, it can be started in the well-established transplant center where complications and outcome of living donor kidney and liver donation are similar or minimal and other alternative ways to provide organ transplants can be attempted. This will overcome the problem of disparity in risk–benefit for DRPs. There is 90% regeneration of liver after living donor liver donation, but no recovery/regeneration of kidney after living donor kidney donation. In living organ donor transplant program where complications of live donor kidney and liver donation are similar, donating the liver will be more beneficial than kidney for living donors.
| Team Work|| |
Transplant team members, stakeholders, national and international transplant societies, and the World Health Organization should come together to discuss the novel way of LDLKEP. It will improve quality of matching and number of live organ donor transplants and reduce waiting time in organ exchange registry. It has the potential to reduce organ traffic and commercialization as it will expand the donor pool. We seek the oversight, cooperation, and assistance of the World Health Organization and national and international transplant societies to carry out pilot LDLKEP with strong international governance that is consistent with the highest ethical and legal standards and that carefully approves participating healthcare providers and DRPs.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Samstein B, de Melo-Martin I, Kapur S, Ratner L, Emond J. A liver for a kidney: Ethics of trans-organ paired exchange. Am J Transplant 2018;18:1077-111.
Kute VB, Shah PS, Vanikar AV, Gumber MR, Patel HV, Engineer DP, et al.
Increasing access to renal transplantation in India through our single-center kidney paired donation program: A model for the developing world to prevent commercial transplantation. Transpl Int 2014;27:1015-21.
Kute VB, Patel HV, Shah PR, Modi PR, Shah VR, Rizvi SJ, et al.
Impact of single centre kidney paired donation transplantation to increase donor pool in India: A cohort study. Transpl Int 2017;30:679-88.
Kute VB, Patel HV, Shah PR, Modi PR, Shah VR, Trivedi HL. A potential solution to make the best use of a living donor-deceased donor list exchange. Am J Transplant 2016;16:3580.