In a first: Three-in-one swap liver transplants performed at PKLI Lahore

LAHORE: For the first time in the history of Pakistan, ‘three-in-one’ swap liver transplants were simultaneously performed at Pakistan Kidney and Liver Institute and Research Center (PKLI-RC) Lahore Thursday where three people donated parts of their livers to unrelated recipients in exchange of liver donations to save lives of their blood relatives.

“Today we have performed one of the most unique swap liver transplant procedures in the history of Pakistan, where three persons, two sons and a daughter, donated parts of livers to unrelated recipients in exchange for liver donations for their fathers. All these surgeries went smoothly ‘Alhamdulillah’ and all the transplant recipients and donors are in good health,” renowned liver transplant surgeon and dean PKLI-RC told The News Thursday.

Liver Paired Donation or swap transplant is a new concept in Pakistan, where a person donates organ or part of their liver to an unrelated person in exchange for organ donation for their blood relatives due to blood group incompatibility or technical reasons.

Two weeks ago, Punjab Human Organ Transplant Authority (P-HOTA) gave approval to swap transplants in the province, allowing patients to have access to the organs from unrelated donors, outside of blood relatives, Dr Faisal Dar informed.

The PKLI-RC dean said three teams comprising five transplant surgeons and other support staff performed the 7-8 hours long procedures simultaneously at six operation theaters at the health facility, during which they removed portions of livers from three donors and then transplanted them to the unrelated recipients at the same time.

“Actually, these three male patients had their own blood relatives as donors but due to mismatch of blood groups and some other technical issues they could not receive the liver donations from their blood relatives. Considering it a case of Liver Paired Donation, we prepared a case of three-in-one swap liver transplant and forwarded it to P-HOTA for approval, which allowed the procedure as per their recently-approved swap transplant policy,” Dr Faisal added.

Explaining the ‘unrelated swap transplants’ Dr Faisal Dar said in order to receive an organ from an unrelated person, the recipient must have a blood relative as donor, whose organ could be transplanted to another person in exchange for donation from that person’s blood relative for him.

“In today’s case, due to blood group incompatibility, technical reasons and issues of tissue matching, liver transplants were not possible within blood relatives so we performed the swap transplants, which saved lives of three people, he added.

When asked as to why they performed three transplants procedure simultaneously instead of doing separately with a gap of a day’s time, he said it was immensely important to do these transplants simultaneously to prevent any of the donors from backing out.

“As these donors were donating portions of their livers for others so we could not take risk of any of them refusing the donation once his or her loved one received the donation from some other person,” Dr Faisal said and added that they don’t have any authority to compel a person to donate his liver for other person once his or her relative had the transplant.

To another query, the transplant surgeon said they had done colour-coding of their theaters to avoid any accident during the surgeries as six operation theaters were used and three teams comprising 18 people were involved in the highly complex and sensitive surgeries under one roof.

“I have performed three liver transplants in 24 hours in the past but they were performed one after the other. This was the first time when three transplants were performed simultaneously under one roof with three different teams,” he further added.

Dr Faisal Saud Dar said a transplant is often the only definitive treatment option for people suffering from liver cancer or cirrhosis but unfortunately, around 30-50% of these patients are unable to find a donor, and in Pakistan nearly 10,000 people die annually waiting for a liver. “In such circumstances, use of a novel algorithm for Liver Paired Donation (LPD) can increase live donor matches in a manner that is safe, ethical, and accessible,” he added.