I heard some people talking at dialysis about doing a “swap.” Can you explain that to me?

Because there is such a shortage of organs donated, there have been some innovative programs developed that use incompatible live donors and recipients. The “swap” that you are referring to is called a paired exchange. There are willing donors but they are unable to donate because their blood types are incompatible or their immune systems were incompatible (they had a positive crossmatch). In a paired exchange a donor and recipient are evaluated and accepted into a participating transplant program. Their information is entered into a computer. Match runs (a computer program that looks for compatible matches in the system) occur every 4 to 6 weeks. If there are any potential compatible pairs, the transplant programs are notified. They review the preliminary data of age, body mass index, and blood type and decide if they want to proceed. Crossmatch testing is done between the pairs, donors, and recipients. If the crossmatch is negative, the donors are further evaluated at the recipient’s transplant hospital. A final crossmatch is done the week before surgery. If this continues to be negative, you proceed to transplantation. The surgery on the donors is performed simultaneously at the various transplant hospitals.