Delhi HC gives nod to four-way kidney swap transplant

The Delhi High Court has given its nod to a multi-way swap kidney transplant in which four patients with chronic renal disease would receive the organ from each other’s close relatives.

Justice Purushendra Kaurav said that the decision of a private hospital’s authorisation committee as well as the appellate authority under the Union Health Ministry, to reject the proposal was contrary to the intent of the Transplantation of Human Organs and Tissues Act, 1994.

Observing that a restrictive interpretation of the law would defeat its purpose to provide access to life-saving transplants, the court directed the hospital’s authorisation committee to expeditiously approve the four-way transplant subject to medical and ethical protocols.

The court passed the order on May 26 on a petition by eight individuals — four recipients and their willing close-relative donors who had positive “cross-match results” that made the swap possible. It was proposed that each donor would give a kidney to a compatible recipient in the chain, enabling all four patients to receive the organ.

The authorisation committee, however, rejected the proposal in February on the grounds of non-exhaustion of near-relative donor evaluation, absence of express statutory provision for multi-pair swaps and the lack of exceptional clinical justification. It was also stated that the possibility of financial inducement cannot be ruled out in such a scenario.

The Appellate Authority also upheld the rejection in April, holding that Section 9(3A) of the Transplantation of Human Organs and Tissues Act only permits two-way swaps. The petitioners, represented by advocates Gayatri Virmani and Disha Gupta, contended that Section 9(3A) was an enabling provision that facilitated swap transplants in cases of biological incompatibility among willing near relatives.

Advocate Sumit Nagpal, who represented the Ministry of Health and Family Welfare, sought time to file a response to the petition, saying it concerned a significant issue. The four recipients who belonged to different parts of the country — Delhi, Bihar, Nagaland and Jammu & Kashmir — were suffering from end-stage chronic kidney disease, and the proposed four-way kidney swap transplantation, they claimed, was the only viable option to save their lives.