The future for organ donation
Around 7,000 people in the UK are currently waiting for organ transplantation.
All have end-stage organ failure, be it kidney, liver, lung or heart, and require a life-saving transplant.
Organs for transplant usually come from bodies of people who agreed to donate before death. But as this does not produce enough organs, Scotland and England plan to bring in an ‘opt out’ system, meaning that on death a person’s agreement to organ donation is assumed unless they had actively opted out.
Live donation is an alternative to awaiting a cadaveric organ. As people can live happily with one kidney or half a liver, family members or altruistic individuals sometimes offer to donate these organs. Since matching donor and recipient tissue-type, however, is generally required these donations are not always acceptable.
Now groups of tissue-type incompatible donor/ recipient pairs are getting together to mix and match, producing duos who are tissue-type-compatible. Let’s say Annie is rejected as a kidney donor for her sister Jean for incompatibility reasons and, similarly, Arthur is rejected as a kidney donor for Jim. But pairing donor Annie with recipient Jim and Arthur with Jean could lead to two successful transplants. A recent report from the US describes the first bi-organ exchange involving a liver-kidney swap*.
In this case, a daughter wished to donate a kidney to her mother with renal failure but was rejected because she might later develop the same kidney problem. So she offered half of her liver in exchange for a kidney for her mother. Another donor was eventually identified who wanted to donate half her liver to her sister with liver failure but was rejected because her liver was too small. But she was cleared for kidney donation. So on the day of the swap, four operations took place and two needy people received life-giving new organs.
Although not presently being considered in the UK, with the ethical issues sorted, this multi-swap procedure opens the way for extended chains of donors and many more lives saved.
*Torres et al Am J transplant. 2019;00:1-4.