Doctor Chen Zhonghua spent last week in a nervous but cheerful frame of mind. His medical team completed a successful live kidney donation for two couples at the Tongji Organ Transplant Institute of Tongji Medical School at Central China Science and Technology University in Wuhan, Hubei Province.

It is the first kidney transplant ever conducted in China between two unknown couples. Zhong Lizhen, wife of Li Chuanxiong, suffering from kidney failure, donated her right kidney to Li Cuiying, inflicted by uraemia, while Wu Zhengtong, Li Cuiying's husband, donated his right kidney to Li Chuanxiong. The whole transplant process only took five hours and involved more than 40 doctors.

"The operation itself was a big success. Also, the two patients have been recovering well. It saves half of my worries," said Chen, head of Tongji Organ Transplant Institute.

Just a month earlier, the two families still waited desperately for suitable kidneys. Though Zhong Lizhen and Wu Zhengtong were willing to donate their kidneys to save their respective partners, unfortunately their blood types did not match those of their partners.

While doctor Chen was searching for a suitable kidney for the two patients, he happened to find that the blood types of the two husbands and the two wives were respectively a perfect match, which is the most basic medical criteria for an organ transplant.

Doctor Chen then invited the two couples to sit together and asked if they were willing to exchange their kidney donations. The two desperate couples readily agreed.

"The organ exchange between different families is a mode worthy of further spreading. It can increase total kidney transplants by 5 to 10 percent," said Chen.

In his clinical practice, he often encountered the situations that the relatives in a family are willing to donate their kidneys but have different blood types from those of the patients.

"Considering the waiting list for a kidney transplant in China is long, the matching probability between different families is high," said Chen.

He started the project last year but only last month did he finally meet two couples with a satisfactory match.

"The key for an organ donation exchange should be to achieve fully informed consent from all participants, particularly the donors. The donors should have a thorough understanding of the whole medical process," said Chen.

In theory, group kidney donation can happen between four families at most. But Chen noted that more families involved result in less chance of matching. He estimated that in the near future there might appear a kidney transplant between three families.

Six years ago when Chen returned home from Britain, he saw a great shortage of organs available for transplant.

"At that time, there were few cases of living kidney donations by family members," said Chen. "Many patients could not get the organs and could only see their condition deteriorate."

According to Chen, the quality of the kidneys donated by living relatives is generally superior to those after death. Transplants from living donors can enable doctors to select the best time of operation.

Also, the time span of kidneys leaving the bodies determines the success rate of a transplant.

In the past years, Chen has been promoting living organ transplants between family members and convincing people that donating one of their kidneys was in fact pretty safe.

So far, the Tongji Organ Transplant Institute has conducted 113 close relative living kidney transplants, whose percentage among total kidney transplants has jumped to 14.5 percent from less than 1 percent six years ago.

Chen said that he wants to increase the percentage of kidneys for transplant coming from relatives' donation or group donation exchange by 35 percent.

No countries in the world can solve the organ shortage problem, but in China, the gap between supply and demand is even bigger, according to Chen.

Every year, there are between 300,000 and 500,000 people waiting for necessary kidney transplants, but only between 50,000 and 60,000 finally received an operation.

Though in the past years Chen and a group of Chinese doctors have been actively pushing forward legislation on brain death, he believed that it would not contribute much to solving the problem of organ shortage in the near future.

In developed countries, 15 percent of the organs for transplant come from none-relative donors, whose desire to donate an organ is based upon the emotion of love for their fellow human being or comes out of an emotional attachment to the recipient.

"Personally I feel that non-relative donors should not be encouraged at present in China," said Chen. He gave three reasons.

First, there is no relative medicare security system to safeguard their rights if they develop donation-related diseases in the future.

Second, at present, there are no rules to guide organ donation from non-relative donors and it will open the gate for organ sales.

Third, the hospitals cannot get to know the real intention of the donors.

"At present, increasing the percentage of relative organ donations is the most effective way to address the organ shortage problem," Chen said.

(China Daily April 19, 2006)