Tuesday, June 6, 2023

In a rare feat, the Medanta Liver Transplant Team successfully performed the country’s first three-way liver transplant swap, or paired exchange, in which three patients suffering from terminal liver disease simultaneously received life-saving liver transplants. The lead surgeons for the three transplants were Dr. AS Soin, Dr. Amit Rastogi and Dr. Prashant Bhangui, respectively.

This three-way swap is a heart-warming tale of how three complete strangers – Sanjeev Kapoor, a businessman from Madhya Pradesh, Saurabh Gupta, a businessman from Uttar Pradesh, and Aadesh Kaur, a homemaker from Delhi – shared common destinies. They were all ill with terminal liver failure, each needing an urgent liver transplant to survive but too unwell to wait for an organ on the deceased donor list which could have taken up to a year. The three patients had willing liver donors within their families, but none were a suitable match. They had all given up hope till the Medanta Liver Transplant Team planned this never-before simultaneous swap surgery that gave all three another shot at life.

Medanta’s Chief Liver Transplant Surgeon, Dr. Arvinder Soin, who led this formidable team effort, said, “We introduced the concept of living donor organ swap (or paired exchange) between two recipient and donor pairs in 2009. Such exchanges help save lives of recipients whose relatives, despite being medically fit, are unable to donate due to blood group and/or liver size incompatibility. After performing 46 such two-way swaps (92 transplants) over the past 13 years, we have now successfully expanded the concept to a three-way swap chain involving three donor-recipient pairs.

These three transplants were performed simultaneously by operating on three donors and three recipients. A team of 55 doctors and nurses worked together in six operating rooms for over 12 hours to complete this Herculean task. While Sanjeev’s donor (his wife) was blood group compatible, her partial liver would have been too small for him. On the other hand, Saurabh’s donor (his wife) and Aadesh’s donor (her son) were both blood group incompatible. The paired exchange was planned in a way that all three patients received an adequate volume of a blood group compatible liver. In theory, as explained in the graphic, this chain can be extended to four, five or even more donor-recipient pairs. Owing to logistic challenges of performing so many liver transplants simultaneously in one center, we are now developing protocols to collaborate and accomplish longer chains of liver exchange at 2 or 3 different centres within the same city.”