Lahore: Pakistan Kidney and Liver Institute and Research Centre (PKLI) Lahore has achieved what it says is the world’s first 10-way living donor liver transplant swap chain, carrying out 20 major operations involving 10 donors and 10 recipients within a single 24-hour period and creating transplant opportunities for patients whose family donors were medically incompatible.
The unprecedented procedure, supervised and led by PKLI Dean Prof Dr Faisal Saud Dar and involving multiple surgical, anaesthesia, intensive care and transplant teams, expanded on the concept of paired donor exchange and surpassed the recently reported eight-way cross-liver transplant carried out in Türkiye.
Speaking about the achievement, Prof Dr Faisal Saud Dar said the successful completion of the world’s first 10-way living donor liver transplant swap chain demonstrated that incompatibility between a donor and recipient should no longer be viewed as the end of the transplant journey.
He said the procedure showed how a larger donor pool and coordinated donor exchange could convert seemingly impossible situations into life-saving opportunities for patients with end-stage liver disease.
A swap liver transplant, also known as paired donor exchange, is performed when a willing family donor cannot donate to his or her intended recipient because of blood group mismatch, inadequate graft size, complex anatomy or immunological incompatibility.
Instead of abandoning transplantation, several incompatible donor-recipient pairs are linked together and each donor gives part of the liver to another compatible patient in the chain, ensuring that every recipient receives a suitable graft while maintaining ethical and legal safeguards.
According to PKLI Dean, the 10-way chain involved patients suffering from hepatitis B and C-related chronic liver disease, hepatocellular carcinoma, Budd-Chiari syndrome, autoimmune hepatitis and biliary atresia.
The reasons necessitating the swaps included blood group incompatibility, low graft-to-recipient weight ratio, complex arterial and venous anatomy and cross-match incompatibility. The exchange ultimately allowed all 10 patients to undergo transplantation.
Prof Dr Faisal Saud Dar said living donor transplantation frequently encounters situations where family members are willing to donate but are medically unsuitable, leaving patients with few options and exposing them to the risk of deterioration or death while waiting for deceased donor organs.
He maintained that structured swap programmes offer an ethical and effective solution by enlarging the donor pool without commercialisation or unfair allocation.
PKLI said all 20 surgeries involving donor and recipient operations were coordinated and completed within 24 hours, highlighting the complexity of the undertaking and the need for extensive planning, multidisciplinary teamwork and intensive postoperative care.
According to Prof. Dar maintained that the achievement came only weeks after surgeons at Inonu University Liver Transplant Institute in Türkiye reported the world’s first eight-way cross-liver transplant and said the successful expansion to a 10-way chain had established a new international benchmark in living donor liver transplantation.
Prof Dr Dar said the experience underscored that the major challenge in transplantation was often not the lack of willing donors but the absence of a sufficiently large donor pool. He called for the creation of a national swap liver transplant programme under which transplant centres across Pakistan could refer incompatible donor-recipient pairs to a central registry where advanced matching systems could identify compatible exchanges among families from different regions.
According to PKLI, such a national referral network could increase transplant opportunities, reduce waiting times, improve outcomes through better matching and ensure equitable access to transplantation irrespective of geography or socioeconomic status. The institute also urged healthcare policymakers, transplant societies and regulators to develop national and international frameworks to facilitate ethical donor exchange programmes while maintaining donor safety and transparency.
Prof Dr Dar said the world’s first 10-way swap chain represented more than a surgical milestone and showed how innovation, collaboration and ethical leadership could transform barriers into opportunities.
“Ten donors, ten recipients and twenty major operations completed within one day demonstrate what coordinated medicine can achieve when patients are placed at the centre of the system,” he said.
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