Kidney transplant donor chains are lifesaving links to hope

January 31, 2025 Swedish Health Team

[4 min read]

In this article: 

  • Every day in the United States, 17 people die every day waiting for an organ transplant. 
  • The U.S. Health Resources and Services Administration estimates that every organ donor can save up to eight lives and enhance the quality of 75 more. 
  • In the case of kidney donations, organs can come from living or deceased donors. 
  • The organ donation program at Providence Swedish recently completed a remarkable 10-person, five-way kidney donation chain that began with a benevolent donor and two compatible friends who allowed their donations to be swapped for recipients in need.  

At Providence Swedish recently, a group of 10 people became inextricably linked in a demonstration of advanced medicine and health care, human compassion and hope for the future. Our nationally recognized, 52-year-old organ transplant program marked a significant milestone: a set of donors and recipients completed a 10-person, five-way kidney donation chain. The chain was the longest in the program’s history and required advanced computer technology, several surgical teams and a host of support services.  

“There are many logistical challenges we have to consider when scheduling living donor transplants,” says Kavita Devairakkam, RN, Providence Swedish’s kidney transplant program manager. “Surgeons must be available, in addition to them having clinics and being on call for deceased donor transplants. We must have blocks of operating room times, and the dates need to be convenient for recipients, donors and their caregivers.”

A beacon of hope 

According to the U.S. Health Resources and Services Administration (HRSA), there were 46,000 organ transplants performed in the United States in 2023. Still, with 17 people dying every day waiting for an organ transplant, it’s clear that for those on the national organ transplant waiting list it is very much a race against time. The HRSA also estimates that every organ donor can save up to eight lives and enhance the quality of life for 75 more. These sobering statistics underscore the life-changing nature of the recent accomplishment at Providence Swedish and the renewed hope organ transplantation represents for so many patients and families.

Living donor kidney chains represent a remarkable innovation in the field of organ transplantation. These chains are designed to match living donors with recipients, creating a sequence of transplants that maximize the number of lives saved. 

The image above illustrates how the chain at Providence Swedish began — with an altruistic individual known as a benevolent donor who chooses to donate a kidney without a specific recipient in mind. In the case of Providence Swedish it was an older teenager who became determined to donate a kidney. Washington State requires that donors be 21 or older, so at 22 years he began the official process of applying to be a kidney donor.  He agreed to participate in a paired exchange—also known as a kidney swap—because his only stipulation was that his donation be maximized to help as many people as possible. This allowed his kidney to be swapped out for donation to a recipient who was incompatible with their identified donor. In this case, a pair of compatible friends who agreed to enter the swap were crucial in achieving the benevolent donor’s initial request that his donation help as many people as possible. 

In a transplant chain, this selfless act sets off a life-saving sequence of events. This donor's kidney is transplanted into a recipient who has a willing but incompatible donor. This incompatible donor, in turn, donates their kidney to a compatible recipient in need, and the chain continues. Much of this matching is done with the aid of a computer algorithm. At Providence Swedish, the chain included a group of donors and recipients of diverse genders, ethnicities, ages, backgrounds and lengths of time on the waitlist.  

The length of kidney chains

“We have done many three-way internal paired living donor exchanges, but this is the first five-way internal paired exchange we’ve done,” says Nidyanandh Vadivel, M.D., the kidney program’s director of acquisition.

The length of a kidney chain can vary significantly. Some chains involve just two or three transplants, while others can extend to dozens of surgeries, spanning multiple hospitals and even countries. The longest recorded chain involved 35 transplants and 70 surgeries.

A transformative gift

Each additional link in a donation chain represents another life saved. Kidney donations—and organ donations broadly­—represent the potential of medical collaboration and the power of altruistic giving to transform countless lives. Anyone who is considering becoming a donor is carefully screened and required to be in good physical and mental health and willing to maintain a healthy lifestyle and have annual medical follow-ups post-donation.

“Organ transplants are very much lifesaving, whether it’s getting a patient off long-term dialysis or curing their irreversible liver disease with a liver transplant,” says Chandrasekar Santhanakrishnan, M.D., FACS, executive medical director of the organ transplant center. “Seeing patients regain their quality of life and be there for their families is gratifying. Transplants provide hope.”

Learn more and find a physician or Advanced Practice Clinician (APC) 

Visit our website to learn more about the Organ Transplant Center at Swedish First Hill.

Whether you require an in-person visit or want to consult a doctor virtually, you have options. Contact Swedish Primary Care to schedule an appointment with a primary care practitioner. You can also connect virtually with your doctor to review your symptoms, provide instruction and follow up as needed. And with Swedish ExpressCare Virtual you can receive treatment in minutes for common conditions such as colds, flu, urinary tract infections, and more. You can also use our provider directory to find a specialist or primary care physician near you. 

Information for patients and visitors 

Related resources 

“They treated me like I was the first kidney transplant patient in history.”

“The most perfect irrational decision I’ve ever made.”

A record year for hope. Swedish marks an unparalleled year for organ transplant in 2023.

Swedish celebrates the gift of life during Donate Life Month

Transplant nurses help give the gift of life

This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions. 

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