Bi‐organ paired exchange—Sentinel case of a liver‐kidney swap

Organ transplantation is the optimal treatment for patients with end stage liver disease and end stage renal disease. However, due to the imbalance in the demand and supply of deceased organs, most transplant centers worldwide have consciously pursued a strategy for living donation. Paired exchanges were introduced as a means to bypass various biologic incompatibilities (blood‐ and tissue‐typing), while expanding the living donor pool. This shift in paradigm has introduced new ethical concerns that have hitherto been unaddressed, especially with nondirected, altruistic living donors. So far, transplant communities have focused efforts on separate liver‐ and kidney‐paired exchanges, whereas the concept of a transorgan paired exchange has been theorized and could potentially facilitate a greater number of transplants. We describe the performance of the first successful liver‐kidney swap. While paired kidney and liver exchanges currently exist to bypass the immunologic barriers for highly sensitized recipients or those with blood type incompatibility, multi‐organ exchange can dramatically increase the number of transplantable organs, as illustrated in this case of a liver‐kidney swap.