Two back-to-back, four-way kidney swaps at UI Health

Eight people received life-saving kidney transplants in two back-to-back, four-way kidney swaps at UI Health. If it weren’t for the sharp eyes of a transplant immunologist, four of the recipients could still be on the waiting list today.

On Monday, April 29, and Friday, May 3, eight people received organs from living donors they didn’t know. In the first swap, two women and two men received kidneys from two men and two women, and in the second swap, three men and one woman received kidneys from two men and two women. All sixteen patients who participated in the two swaps are doing well.

People often volunteer to see if they are a good match for donating a kidney to a loved one in need. A compatible match is one where the donor and recipient have the same blood type and have several matching immune factors. Compatibility between donor and recipient increases the chance that the recipient’s body will accept the new kidney.

If the transplant immunologist, tasked with evaluating donor/recipient matches, notices that a prospective donor is compatible with another recipient who has their own living donor but with whom they are incompatible, the coordinator may reach out to that donor to ask whether they would be open to donating a kidney to someone they match with but don’t know. The original donor’s matched recipient would be paired with a new compatible donor. In a kidney swap, all recipients involved must have a living donor.

“Usually when a swap happens, a compatible pair will altruistically agree to swap to help other pairs,” said Dr. Sujata Gaitonde, associate professor of clinical pathology in the University of Illinois at Chicago College of Medicine and one of the UI Health’s transplant immunologists. “In other words, a pair who doesn’t need to swap to benefit themselves as they are already compatible will agree to swap in order to give a compatible organ to a recipient whose donor is incompatible.” 

The path to the swaps began when Gaitonde noticed that the donors of two compatible donor/recipient pairs were also compatible with two recipients on the kidney transplant waiting list whose living donors weren’t compatible matches.

Gaitonde asked the hospital’s kidney transplant coordinators to reach out to the two donor/recipient matched pairs: two men who were best friends and a couple. The coordinators told the donors in these two matched pairs that they also matched with two recipients whose living donors weren’t a match. The good news was that if the donors agreed to give their kidneys to the strangers, the stranger’s donors would give their kidneys to their recipients who they also happened to match with. In other words, they could help save four lives instead of just two.

The matched donors agreed and the swap was arranged. From there, Gaitonde noticed potential beneficial matches among other pairs who also agreed to a swap.

Over the course of about 20 hours total, seven surgeons and numerous residents and other medical staff completed the two kidney swaps just a few days apart.

“We have never before done four-way kidney swaps at UI Health, and to do two so close together is quite remarkable,” said Dr. Enrico Benedetti, professor and head of surgery at UI Health. “We are pleased that we were able to coordinate so that more people could benefit from available organs, but it was these pairs themselves who agreed to the swap who really enabled this life-saving swap.”

“One of the benefits of kidney swaps is that often recipients end up with organs that are better matched in terms of age and gender,” said Dr. Ivo Tzvetanov, chief of transplant surgery at UI Health. “In this case, we had some better age matches for recipients due to the swap.”