How Max Hospital Performed North India's First Four-Way Paired Kidney Transplant

Max Super Speciality Hospital, Saket, has achieved a significant medical milestone by successfully performing North India's first four-way paired kidney transplant, offering new hope for patients facing donor incompatibility challenges.

A private hospital in Delhi has performed a four-way paired kidney transplant, involving four patients and four donors from Jammu and Kashmir, Delhi, Bihar and Nagaland, officials said. In a statement, the Max Super Speciality Hospital, Saket, claimed it was the first such procedure performed in north India. The transplant involved four donors who were unable to donate kidneys directly to their loved ones due to blood-group mismatch or other medical incompatibilities. Under a paired-exchange programme, each donor was matched with a compatible patient from another family, allowing all four recipients to receive kidneys.

Understanding Paired Kidney Exchange

The transplants were performed on July 13 and involved eight surgeries on the same day †four donor nephrectomies and four kidney transplants. The patients and the donors are recovering well and have been discharged from the hospital, the statement said. The procedures began at around 7 am and were completed by about 6 pm, involving five operating theatres functioning simultaneously, the hospital said.

Diverse Donor-Recipient Pairs

The four donor-recipient pairs were from different parts of the country. Tsutsangla Pongen (34) from Nagaland required a second transplant but had developed donor-specific antibodies against her brother Arikokba Pongen (28). Abdul Rouf Bhat (47) from Jammu and Kashmir was awaiting a second transplant and could not receive a kidney directly from his sister Nazneen Rehman Bhat (42) due to immunological incompatibility. In Delhi, Shivani Khurana (46) could not receive a kidney from her husband Varun Khurana (49) after developing antibodies against antigens shared by him following pregnancy and a previous blood transfusion. The fourth pair, Law Bahadur (34) and his wife Nidhi Kumari (36) from Bihar, could not undergo a direct transplant due to incompatible blood groups, the statement said.

The Complex Process And Regulatory Hurdles

After detailed blood-group testing, HLA typing, cross-matching and immunological evaluation, the four pairs were linked into a single exchange. Varun Khurana donated his kidney to Tsutsangla Pongen, Arikokba Pongen donated to Law Bahadur, Nidhi Kumari donated to Abdul Rouf Bhat, and Nazneen Rehman Bhat donated to Shivani Khurana. The team used the 'Alliance for Paired Kidney Donation' software to identify suitable donor-recipient combinations, supported by detailed immunological testing to assess the safety and feasibility of each transplant. As the procedure was the first four-way paired kidney exchange of its kind in North India, obtaining regulatory approval involved extensive documentation, repeated presentations and detailed scrutiny, the hospital said. The matter ultimately required an appeal to the Delhi High Court before the necessary permissions were secured, it said.

Expert Leadership And Future Implications

The transplants were carried out under the leadership of Dinesh Khullar, Group Chairman, department of nephrology and renal transplant medicine, and Anant Kumar, Chairman, department of urology and kidney transplantation, Max Saket, in collaboration with Shafiq Ahmed, Senior Director, urology, andrology and renal transplant, BLK Max Hospital, and his team. "Paired kidney exchange can open a new avenue for patients who have willing donors but are unable to undergo direct transplantation due to blood-group or immunological incompatibility," Khullar said. Kumar said the success of the four-way exchange demonstrated what could be achieved when families coordinate, and surgical teams execute a carefully coordinated plan for simultaneous procedures. Ahmed said greater awareness and participation in kidney exchange programmes could help make better use of the limited pool of living donors and create more opportunities for patients waiting for suitable kidneys.