Times of India
06 April 2010
By Malathy Iyer
Mumbai, India

Nephrologist Dr Madan Bahadur at Mumbai’s railway hospital say when Dev Sareen and Mahinder Sharma, both suffering from renal failure, required kidney transplants, a peculiar situation presented itself. “Mahinder’s blood group was B+, his wife Madhu’s was O+. She was willing to donate one of her kidneys to him which was medically perfect. But we had the exactly opposite situation with the Sareens; while Dev was O+, his wife Vimla was B+,” Bahadur said.

A solution–if the Sharmas were willing–would have been swap transplants between the couple. “But the Sharmas did not need to go out of their way to donate their O+ kidney to others. Madhu could well have given her kidney to her husband,” said Bahadur. But the Sharmas didn’t need a second counselling. “We both know what a struggle it was to undergo dialysis every week and wonder about our children’s future,” said Madhu and Mahinder. The decision made, the inter–city swap surgery took place in Jaslok Hospital on January 14.

The significance of this swap, said Bahadur, was that it involved an O+ recipient. “About 50% of the Indian population has O+ blood group. Hence, most of kidney failure patients too have O+ bl–ood group. They are disadvantaged because they can receive kidneys only from O donors who have to be their relatives. But this doesn’t always happen. So, if swaps become common, it would obviate the need for any unrelated transplants,” he said.

Apart from altruism, there is an underlying medical message in the Sharma–Sareen swap story. It is about the need for HLA matching between donors and recepients. Human leukocyte antigen (HLA) are protiens found on most cells of the body, which uses these protiens to recognise cells that belong to the body. “So a closer HLA matching would mean less chance of a rejection,” said Bahadur.

In the Sharma–Sareen case, the HLA matching between the O recepient–donor and the B recepient–donor was good. Incidentally, Mumbai has witnessed the largest number of swaps in the country, with Jaslok Hospital accounting for most. At a recent press conference on the subject of kidney swaps, Dr Pravine Shingare of the department of medical education and research (DMER), said that rules governing swaps should be simplified. “The government has written to the union health ministry to recognise swaps on par with transplants within families,” he had said. There also is a feeling that swap transplants could help reduce the need for “buying” kidneys.

Life–Saving Exchange

• PROBLEM: Two couples with the husbands suffering from kidney failure
• SOLUTION: The wives gave kidneys to each other’s husbands
• NOVELTY: Though one couple could have gone ahead with the swap among themselves, they went ahead with a swap transplant with the other (the patient was O+) as O+ patients don’t easily get a donor

Also, with the O–to–O and B–to–B transplants, the genetic HLA matching is better. So the transplant has less chance of failure