The two couples never got to know each other because a crossover, known internationally as “Crossover”, is carried out anonymously in Austria. And yet they have taken on a fateful role in each other’s lives. In autumn there was a hit in the database, as the hospital operating company (KHBG) announced in a broadcast on Monday, meanwhile both couples have the operations behind them. The “crossover” issue was made possible by a mutual agreement of the necessary physical tissue characteristics and blood groups. A pretty rare stroke of luck.
A team from the Nephrology and Dialysis department at the Feldkirch State Hospital provided the two couples with medical care beforehand and afterward. The interventions themselves were carried out – for both couples at the same time – in the transplant center of Innsbruck University Hospital.
Dedicated register for “crossover expenses”
If a direct living donation is not possible or very difficult, there is the possibility of “crossover” or “kidney exchange” (kidney paired donation). This voluntary option of “kidney exchange” is offered in many countries around the world, and Austria also started its own program around ten years ago.
All transplant centers nationwide (Innsbruck, Graz, Linz and Vienna) take part. For a kidney exchange donation, the same legal regulations apply as for a life donation among minors or friends.
Search for suitable combinations
In 2020, couples from Vorarlberg made up of patients and donors were put on this list for the first time. You are thus taking part in a computer-controlled program that filters out immunologically suitable combinations from the listed participants.
If there is a match, the donated kidney does not go to the person close to you, but to a “strange” recipient from another couple on the list, whose tissue also did not match.
In return, the first couple then gets the kidney of another donor: “It can be a direct exchange between two couples, but organs can also be exchanged in larger groups. The most prominent example is the replacement of 30 kidneys in a group of 60 people in the USA,” explains nephrologist Hannelore Sprenger-Mähr, senior physician in the “Nephrology and Dialysis” department at Feldkirch Regional Hospital. The operations of the “crossover” pairs take place at the same time as possible in order to create the same conditions for everyone.
Four-year waiting period for donations from deceased persons
In general, the average waiting time for a kidney for a patient in Vorarlberg is around three to four years. Almost 40 people in the country are currently waiting for a donor kidney, and an average of 15 are transplanted each year.
This waiting time can be shortened by a life donation from a healthy person. If no living donor can be found within the family or circle of friends, then the patients – if they meet the medical criteria – are routinely put on the international Euro-Transplant waiting list (donations from the deceased).
Until they get organs, dialysis does the job of the diseased kidneys, and the blood is machine-cleaned. “When we treat patients in the outpatient clinic who we know will soon need dialysis, we draw their attention to the fact that transplantation is also a possibility of renal replacement therapy. In our experience, it’s even the best option for anyone who is physically fit for it,” says Sprenger-Mähr.
Living donation can save dialysis
In Vorarlberg, an average of two to five people a year receive a kidney from living donors in their personal environment. “If you are lucky enough to know from the outset that there are relatives, partners or friends who would agree to a life donation, you can even save yourself the necessary procedure several times a week and get a new kidney without having to have dialysis,” the specialist knows.
Life donations in this country are most frequently made between spouses, siblings and between parents and their children. “In the case of children and young adults who are about to have dialysis, parents are actually always willing to be screened for this possibility.”
health before old age
Not every person is automatically suitable for a transplant, not every body is healthy and fit enough to be operated on and accept a foreign organ. However, age does not play the decisive role.
“There are certain medical criteria that patients must meet in order to be placed on the donor waiting list. Regardless of whether they are 70 or 20 years old,” Sprenger-Mähr: “A maximum of 25 to 30 percent of our dialysis patients at the LKH Feldkirch are suitable for a transplant. Patients who, in addition to their kidney disease, also suffer from severe diabetes, vascular diseases, heart disease or cancer are out of the question.”
Another prerequisite for a transplant is that the tissue of the donor and recipient is immunologically compatible. This applies to living donations as well as to the transplantation of organs from the deceased.
Good quality of life with only one kidney
The two couples, for whom a crossed living donation was carried out for the first time in Vorarlberg in September 2021, were lucky that, in addition to the match of their tissue characteristics and immunological properties, their age was also comparable: “All four were very fond of the crossed donation open minded. It’s a big step to donate an organ to other people – in this case even to someone you don’t even know!” Today, a few months later, everyone’s health is good.