On May 24, 2025, MOHAN Foundation (MF) and the Network and Alliance of Transplant Coordinators (NATCO) organized a masterclass titled "Swap Transplantation: A Simpler, Ethical Approach to Increasing Transplants" for MOHAN Foundation employees and NATCO members.
The session featured esteemed experts including:
• Dr. Michael Rees, CEO, Alliance for Paired Kidney Donation (APKD)
• Dr. Vivek Kute, Professor of Nephrology and Transplantation, Institute of Kidney Diseases and Research Centre – Institute of Transplantation Sciences (IKDRC–ITS), Ahmedabad
• Dr. Dinesh Khullar, Chairman, Department of Nephrology and Renal Transplant Medicine, Max Super Specialty Hospital, New Delhi
• Ms. Bhavna Shah, Manager, Medical Administration, Dr. L. H. Hiranandani Hospital, Mumbai
The session was moderated by Ms. Pallavi Kumar, Executive Director, MOHAN Foundation, and Ms. Jaya Jairam, Project Director, MOHAN Foundation.
The masterclass aimed to provide valuable insights into swap transplantation and guide transplant centres on how to initiate and facilitate such programs ethically and efficiently.
Dr. Michael Rees emphasized the transformative potential of paired kidney donation in increasing the living donor pool and reducing transplant waitlists. He stated that paired donation could boost living donor transplants by 20–30%. A key enabler of this growth is the use of advanced matching software, which enables complex kidney exchanges more efficiently than manual methods.
Dr. Rees announced a grant-supported initiative to provide free access to the APKD matching system for two years to Brazil and India—both low- and middle-income countries. He also noted that the National Organ and Tissue Transplant Organization (NOTTO) has encouraged the implementation of state-level swap transplant programs to improve transplant outcomes and reduce waiting times.
Dr. Vivek Kute highlighted the significance of swap transplants in improving access to kidney transplantation across India, particularly in government and charitable hospitals. Citing NOTTO’s 2021 data, he noted that India ranks third globally in organ transplantation, with living donations accounting for 85% of kidney transplants. However, about one-third of potential living donors are rejected due to incompatibility—an issue that swap transplantation can address effectively.
Dr. Kute pointed out that Gujarat leads the country in swap transplants, followed by Maharashtra, Delhi, Rajasthan, Punjab, and Kerala. At IKDRC–ITS alone, over 7,000 kidney transplants have been performed. He shared findings from a publication titled “Impact of single centre kidney exchange transplantation to increase living donor pool in India: a cohort study involving non-anonymous allocation,” which analyzed 539 swap transplants—75% of which were two-way exchanges, 16% three-way, and fewer than 10% ten-way exchanges.
In January 2025, IKDRC achieved a landmark with India’s first seven-way kidney swap, performing 17 swap transplants over just two weeks. Dr. Kute strongly urged transplant centres to counsel families about swap options before registering patients for deceased donation, promoting swap transplantation as a crucial strategy to reduce wait times and save lives.
Ms. Bhavna Shah discussed the legal framework surrounding swap transplants, highlighting the vital role of transplant coordinators in educating and supporting patients and their families. She noted that several hospitals in Mumbai have developed internal swap registries and actively promote swap options. Ms. Shah also detailed the legal documentation required under the Transplantation of Human Organs and Tissues Act (THOTA), which ensures ethical and legal compliance in such cases.
Dr. Dinesh Khullar shared his experience establishing a kidney exchange program across Max Hospitals in the Delhi NCR region. He emphasized the critical role of transplant coordinators in scaling paired exchange programs. While two-way swaps have been the most feasible historically, the use of matching software has now made multi-way exchanges—up to ten-way chains—practical and efficient. Unlike manual allocation, which restricts swaps to simpler matches, software enables longer chains and better match optimization.
Dr. Khullar also addressed barriers to wider adoption, particularly in private hospitals where patients often expect faster transplants. Some hesitate when swap donation is suggested due to concerns about potential delays. He stressed the need for effective counselling and education to manage such expectations. He also expressed a strong preference for paired exchange over ABO-incompatible transplants, citing lower associated risks. While India’s long-term goal should be to expand deceased donation, he urged collaboration among transplant centres to strengthen the paired exchange network in the interim.
The session was well-received, with 91 participants attending the masterclass.
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