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  • Simone Bacilieri

International cross-kidney donation saves lives in Portugal

Cross-kidney donation is a promising strategy for increasing access to kidney transplantation,

especially for patients with HLA or AB0 incompatibility. The SAT program has been successful

in Portugal, enabling the transplantation of several incompatible pairs.


Article: Francisco JT, Carvalho R, Freitas J, Coimbra MT, Vilela S, Almeida M, Tafulo S, Pereira RC, Bolotinha C, Ivo M, Sampaio S, Ribeiro C, Silvano JL, Malheiro J, Pedroso S, Dias L, Martins LS. International cross kidney donation - The experience of a single center. Brazilian Journal of Transplantation. 2023, 26(01):e3423.


International cross-kidney donation saves lives in Portugal

Kidney transplantation is emerging as the main approach to treating end-stage renal failure, but the global shortage of organs remains a significant challenge. Even the option of living donor transplantation faces obstacles, such as HLA or AB0 incompatibility.

One solution to this problem is crossed kidney donation, a concept first described in 1986 (Rapaport, 1986) and performed in 1991 in South Korea. This procedure occurs when two donor/recipient pairs are compatible with each other, but not with their own recipients. In these cases, the two pairs are transplanted simultaneously.

Since 2017, Portugal has been part of the international cross-program South Alliance for Transplants (SAT), comprising ten Spanish hospitals, three Italian hospitals, and one Portuguese hospital. Taking place every four months, the program exclusively selects incompatible pairs. Organ transportation is carried out in partnership with the Portuguese Air Force.

The article "International cross kidney donation - The experience of a single center", published

in the Brazilian Journal of Transplantation (vol. 26), presents the positive results of three international crosses that took place between 2020 and 2021, in collaboration with Spanish hospitals.

In the first transplant, in March 2020, during the beginning of the COVID-19 pandemic, a Portuguese patient, incompatible AB0 with a national donor, found compatibility with a Spanish donor. The other two transplants, carried out in December 2021, followed the same dynamic, demonstrating the program's effectiveness in overcoming national barriers.

"Our experience and that of other places shows that programs like these offer numerous benefits, such as widening the pool of available donors, improving compatibility between donors and recipients and avoiding the costs and risks associated with desensitization therapies for transplants with ABO or HLA incompatibility" say the authors.

At the end of the study, the authors also point out that expanding similar programs could increase the number of transplants performed and reduce waiting times, as long as there is continued support and a significant effort to raise awareness and education about these programs.


Read more (References):

Rapaport, F.T. The case for a living emotionally related international kidney donor exchange registry. Transplant Proc. 1986 [cited 2023 Mar 13]; 18(3):5-9. Available from:



Simone Bacilieri



Brazilian Journal of Transplantation

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