In a significant step to improve access to life-saving kidney transplants, the Indian government is set to implement a nationwide programme to promote and streamline swap transplants across the country

Nearly two decades after two Mumbai-based couples pioneered a paired kidney exchange to save each other’s spouses, the central government is taking a major step to promote swap transplants across the country.

Kidney transplants in India are typically conducted using organs donated by a family member or a matching deceased donor. However, in cases where a willing donor is incompatible due to blood group or tissue mismatch, swap transplants also known as paired kidney exchanges offer a promising alternative. This method allows two or more incompatible donor-recipient pairs to exchange donors, enabling successful transplants for all recipients involved. Internationally, this approach has been widely accepted and practised.

Although swap transplants were formally recognised in India under the Transplantation of Human Organs Act in 2011, their uptake has been limited, with only a few hundred such procedures performed over the years.

To address this gap and scale up swap transplant numbers, the National Organ and Tissue Transplant Organisation (NOTTO) issued a directive on April 16 to all states and union territories. According to the NOTTO report, the directive calls for the implementation of a unified national approach under the banner of the “One Nation, One Swap Transplant Programme.” It also outlines the requirement for a standardised set of documents to streamline the approval process for swap donations.

According to the NOTTO report, individuals seeking swap transplants must now submit the specified documentation to their respective State Authorization Committees to initiate the process.

Medical experts have welcomed this initiative, stating it could lead to a 15 per cent increase in transplant procedures across the country. Dr Jatin Kothari, founder of the Apex Swap Transplant Registry, expressed hope for the establishment of India’s first national registry dedicated to swap transplants. He noted that such registries already exist in the U.S. and across Europe, enabling greater coordination and matching opportunities.

With the launch of a centralised system and supportive policies, India moves closer to making life-saving kidney transplants more accessible and efficient for patients in need.