• National registry suggested for incompatible donor-recipient pairs• Proposal follows unique 10-way donor-exchange liver transplant chain LAHORE: Experts from the Pakistan Kidney and Liver Institute & Research Centre (PKLI&RC) have proposed the establishment of a National SWAP Liver Transplant Programme for Pakistan with the primary objective of facilitating life-saving transplants for patients who are unable to receive organs from family members or blood relatives due to blo­od-group incompatibility or other medical reasons. Since its inception, PKLI’s surgeons have successfully performed 2,000 kidney and liver transplants. A senior medical expert said the proposal was put forward by a panel of senior surgeons on the day the institute achieved what it described as another milestone in transplantation medicine by successfully performing the world’s first 10-way Living Donor Liver Transplant (LDLT) SWAP Chain, enabling 10 patients to receive life-saving liver transplants through a coordinated donor-exchange programme. He explained that a SWAP liver transplant is performed when a willing family donor cannot donate to the intended recipient because of blood-group incompatibility, inadequate graft size, or other medical reasons. “If a patient’s relative is an incompatible match due to blood type, liver size, or other factors, the donor can donate to another patient, whose incompatible relative, in turn, donates to the first patient,” the expert said. The SWAP liver transplants were performed by senior surgeons of the institute under the supervision of PKLI&RC Dean Prof Dr Faisal Saud Dar. The senior doctor said the achievement came a few weeks after surgeons at Inonu University Liver Transplant Institute in Turkiye reported the world’s first eight-way cross-liver transplant. The successful expansion to a 10-way chain has established a new international benchmark in living-donor liver transplantation. He said all 10 donor-recipient exchanges were completed within a 24-hour period. Discussing global practices, he said that instead of abandoning transplantation when donor-recipient pairs are incompatible, several incompatible pairs can be linked together. 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. PKLI&RC Dean Prof Dar said all 20 surgeries involving donors and recipients 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. “The initiative transformed 10 incompatible donor-recipient pairs into successful transplant opportunities, demonstrating that donor incompatibility need not be the end of a patient’s transplant journey,” he said. Through a carefully designed exchange system, each donor was matched with a compatible recipient within the chain while maintaining the highest scientific, medical, ethical, and legal standards. Prof Dar said SWAP liver transplantation is an established and ethical form of transplantation permitted under Pakistan’s regulatory framework. He said the challenge in many transplant cases is not the absence of willing donors but the lack of compatible donors. Regarding the proposal to establish a National SWAP Liver Transplant Programme, another senior doctor said the initiative would create a centralised registry for incompatible donor-recipient pairs referred by transplant centres across the country. The registry would facilitate advanced matching, reduce waiting times, improve outcomes, and ensure equitable access to transplantation regardless of geographic location or socioeconomic status. Notably, he said, the 10 transplant recipients came from different parts of Pakistan, including Sindh, Punjab, and Khyber Pakhtunkhwa. Published in Dawn, June 26 , 2026