Paired organ exchange can be used to circumvent living donor-recipient ABO incompatibilities. Herein, we present the first case of successful liver paired exchange in North America. This 2-way swap required 4 simultaneous operations: 2 living donor hepatectomies and 2 living donor liver transplants. A nondirected anonymous living donor gift initiated this domino exchange, alleviating an ABO incompatibility in the other donor-recipient pair. With careful attention to ethical and logistical issues, paired liver exchange is a feasible option to expand the donor pool for incompatible living liver donor-recipient pairs.
Keywords: ABO incompatibility; clinical research/practice; donors and donation: living; donors and donation: paired exchange; liver transplantation/hepatology; liver transplantation: living donor.
© 2020 The American Society of Transplantation and the American Society of Transplant Surgeons.