Bengaluru: Karnataka govt Monday released updated guidelines permitting multi-pair kidney exchange (swap) transplants, broadening organ donation beyond the traditional two-way swaps to include three-way and larger combinations.The move seeks to tackle a major hurdle in kidney transplantation: biological incompatibility between donors and recipients. Many patients are currently unable to receive transplants due to blood group mismatches, positive crossmatches, or HLA (Human Leukocyte Antigen) incompatibilities. HLA incompatibility occurs when donor and recipient (or mother and fetus) have different Human Leukocyte Antigen types, prompting the immune system to recognize tissues as foreign.Multi-pair exchange In a standard transplant, a donor gives a kidney directly to their intended recipient. However, when they are incompatible, multi-pair swaps offer a solution: three or more incompatible donor-recipient pairs are matched in a chain, allowing each recipient to receive a compatible kidney from another pair’s donor. This approach greatly improves the chances of patients in need successfully receiving a transplant.The Transplantation of Human Organs and Tissues Act (THOTA)-1994 explicitly has provisions for two-way swaps, although multi-pair swaps have been authorised by committees on a case-by-case basis in many states across the country. The order issued by the Karnataka govt has emphasised that according to the Act, there is no legal prohibition on multi-pair exchanges. The move follows legal opinion and a Supreme Court judgment supporting broader interpretation of the law.Under the new guidelines, donors must be close relatives of their intended recipients, and each pair must have documented medical incompatibility. Donors, however, need to be compatible with the recipient they are matched with in the swap pool. All participants are required to sign a joint agreement, and the process must undergo comprehensive medical, psychological, and legal evaluations. Any commercial transactions are strictly prohibited.The guidelines also mention that every case will require prior approval from the authorisation committee, with the State-Level Authorisation Committee overseeing multi-pair swaps. Compatibility tests must be certified by NABL-accredited laboratories, and all donors and recipients will be interviewed, and their videos will be recorded.The govt has also directed that the surgeries must be conducted simultaneously or in a closely coordinated sequence and has also told hospitals to report all cases to state and national transplant registries and ensure long-term follow-up.Given the novelty of such procedures in Karnataka, initial cases will be treated as special cases with additional scrutiny, the guidelines noted.
