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Multi-pair kidney swapping works by linking three or more donor-recipient pairs into a group. (Representational image)
In a significant move that could help patients awaiting a kidney transplant, the Karnataka Government has issued guidelines permitting multi-pair kidney paired swap transplantation. This will expand the scope of organ donation beyond the traditional two-way system.
The Karnataka Multi-Pair Kidney Exchange Transplantation Guidelines 2026 were issued via a government order on April 4.
“A significant number of donor-recipient pairs in Karnataka are unable to undergo transplantation on account of biological incompatibility… Applications have been received from registered transplant hospitals in Karnataka seeking approval for multi-pair Kidney Paired Exchange Transplantation involving three or more donor-recipient pairs,” the order said.
Until now, under the Transplantation of Human Organs and Tissues Act (THOTA) 1994, swap donations were limited to two incompatible donor-recipient pairs. Each donor had to be a near relative of their intended recipient, and the swap was confined to a simple two-way exchange. This left many patients unable to undergo transplantation due to incompatibilities such as ABO blood group mismatch and others.
Swap donation means that when two families each have a donor and a recipient, but the donor is biologically incompatible with their own relative, the donor from one family gives a kidney to the recipient in the second family, and the donor from the second family gives a kidney to the recipient from the first family. Under section 9(3A) of THOTA, such an exchange was allowed only between two pairs.
Under the new guidelines, multi-pair kidney swap transplantation will be permissible, subject to eligibility conditions. Multi-pair kidney swapping works by linking three or more donor-recipient pairs into a group. Each donor who is incompatible with their own relative instead donates a kidney to another patient in the group, while their relative receives a compatible kidney from a different donor in the same group.
Approval mechanism for the transplant, mandatory documentation process, ethical safeguards and others are detailed in the guidelines.
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