As we all are aware of, kidney failure is a major healthcare problem facing our citizens.
Transplantation is the preferred treatment for patients with kidney failure as compared to dialysis. The limitation to this is the availability of a compatible donor kidney. One way to get a compatible kidney is via a donor who is a family member, or through a deceased donor (DD). A deceased donor is one who donates his organs to wait-listed patients in the deceased donor registry, once he/she satisfies the criteria of brain stem death. Countries differ in the laws that govern such transplants.
Most of the patients with kidney failure remain on dialysis because they do not find a deceased donor, don’t have a family donor, or the family donor that they do have is incompatible.
While the Government continues to support and encourage the cadaveric kidney transplant program across the state, it is very evident there is a huge demand-supply mismatch. To mitigate this problem to some extent, the Apex Swap Transplant Registry (ASTRA) – a paired exchange registry, was established in 2011. It has leveraged the principle of databasing incompatible donor-recipient pairs and utilising mathematical models to find a solution for the problem of organ shortage.
What is a Swap Transplant And Who Needs It?
When such a patient has a living donor who is however incompatible, then such pairs either undergo an ABO incompatible transplant (if they are blood group incompatible), or they register for a paired kidney exchange program. By doing a swap, two patients with kidney failure who in normal circumstances cannot undergo a transplant because of blood group mismatch or a tissue incompatibility within that family, can now go ahead with kidney transplantation
In India, paired kidney exchange is legal. Mutual compatibilities can be found between pairs in such registries, which pave the way for a kidney exchange between such pairs. Paired kidney exchanges (PKE) can be performed as binaries (swaps), but more patients can benefit if such swaps are extended into longer chains or cycles with help of ASTRA.
Once there is a match, your nephrologist will be informed and your surgery will be done by your transplant team at the hospital of your choice. ASTRA will only generate compatible pairs, hand them over to the respective nephrologists and not do anything beyond this.
So What exactly is Paired Exchange or a Swap Transplant?
Kidney exchange or ‘swap’ is a simple kidney barter system. It is a ’give and take’ deal between two pairs of people, each pair consisting of a giver and a taker, where each pair benefits by receiving a suitably matched organ. In this simple barter framework, it is possible to maximise returns exponentially when the pool is large and complex algorithms for exchange are built into it. A swap pair consists of a recipient (patient) and a donor (a family member) who cannot donate an organ to each other. Such pairs register within the ASTRA database. ASTRA then runs an application based on a mathematical model and searches across the database for compatible pairs. It then generates simple binary donor recipient pairs or complex chain like the current domino.
Swap Transplants Are Important For Certain Patients
Patients with kidney failure who have a door in the family but the blood groups are incompatible.
Patients with kidney failure who have a blood group compatible donor, but their lymphocyte cross-match is positive.
Patients with kidney failure who have a suitable donor within the family, but such a donor has tested positive for Hepatitis B or C. Such patients may enter the ASTRA to find a possible virus positive recipient so that the respective transplants can go through. Such pairs will have to however undergo mandatory liver tests to assess their liver function status as well as their suitability to give and receive a kidney.
Patients who have an elderly donor or a marginal donor with a compatible group can also register to get a donor who is better.
The Apex Swap Transplant Registry and Its Accomplishments
Today ASTRA is 7 years old. Within this short period, 300 donor-recipient (D-R) units have registered within ASTRA. Altogether 65 transplantable pairs were matched; 57 swap transplants have been done and many more are in the process of completing formalities to undergo the transplant. There has also been an international swap generated from this database. The country’s first transplant in a complex domino loop of 5 simultaneous pairs has been performed on 25th June 2013 followed by largest 6 pair exchange domino 25th January 2014. All this has emerged from the ASTRA database.
Along with IIT Mumbai, ASTRA has developed an online application to register patients and their donors for paired exchange. This application uses an algorithm to match recipients with donors not only based upon blood groups, but several other parameters to ensure the highest level of match to translate into a maximum patient and graft survival. This can eventually be a national resource where different geographies can create their own sub registries using this application and create matches for paired exchanges at City/ state/Region and National level. This would be monitored by the appropriate Governmental agency.
ASTRA has presented and published extensively in India and overseas at many Nephrology and Transplant conferences, and along with IIT Mumbai has developed a novel theoretical model for organ transplants called the Apex algorithm. This is a model involving the linkage of the registry with the Cadaveric Registry and it clearly demonstrates how the gains can be exponential by this approach.
It is an initiative to provide a suitable organ for a subset of the kidney failure pool that has an available but incompatible donor in the family. By merely leveraging the database, ASTRA has demonstrated the power of such an approach to overcome the problem of organ shortage and augment transplant numbers. Aligned with the philosophy of the Apex Kidney Foundation, ASTRA believes that a human organ is an invaluable resource, and therefore providing an appropriately matched organ is priceless. Hence this service comes free of cost to patients. ASTRA, once adopted by the entire nephrology community, has the potential to be a national resource.
To register please contact us on the numbers given below.
For More Information please contact:
Coordinator Apex Swap Transplant Registry
ASTRA is an initiative of the Apex Kidney Foundation and is based at Sushrut Hospital, Swastik Park, Chembur. www.apexkidneycare.co\ASTRA
+91-90290-69060/ +91 90299 38711