BATTLING for survival on different continents, an 18-month-old Nigerian child and an Indian housewife, suffering from advanced liver failure, have virtually given each other a new lease of life and the answer to the problem of organ donor shortage.

Dike Ezeanya, son of a Nigerian businessman, and 44-year-old Priya Ahuja have undergone what is being claimed as the first successful swap liver transplant, also called paired donation, for which a team of 35 doctors laboured for 26 hours in four operating theatres.

"In such cases, an incompatible pair of donor and recipient are matched with another incompatible donor or recipient pair and the livers are exchanged between them," Dr. A.K. Soin, chief liver transplant surgeon, Sir Ganga Ram hospital (SGRH) said.

Five months after his birth, doctors diagnosed Dike with Billiary Atresia - a rare condition of newborn infants in which the common bile duct between the liver and the small intestine is blocked or absent. If unrecognised, the condition leads to liver failure. And this is exactly what happened to Dike. On the other hand, Priya's state was also critical. Already suffering from advanced liver failure due to Hepatitis C infection, she was later diagnosed with tuberculosis.

With transplantation being their only hope, doctors hit a dead end - unavailability of compatible cadaver donors. But by a stroke of luck, Dr. A. K. Soin, chief of liver transplant unit, Dr. Neelam Mohan, paediatric hepatologist and Dr. Sanjiv Saigal transplant hepatologist found that the blood group of Dike's mother, Chinwe, was A which matched with Priya. On the other hand, Priya's husband, Haresh, belonged to the blood group B which was the same as Dike.

A 35-member surgical team then took 50 per cent of Chinwe's right liver and transplanted it into Priya while Hariesh gave 20 per cent of his left liver to save Dike. Almost two months after the surgery, both Dike and Priya are now in normal health.

According to Mohani: "While both donors' blood groups did not match their own recipients', they were suitable for the other recipient. Dike's father had the same blood group as the kid but he had very fatty liver and so wasn't a suitable donor. When we suggested the idea of a donor exchange, which is also called paired donation, both families jumped at the opportunity.

"The blood groups of Dike and his mother Ezeanya Chinwe, the donor, were B positive and A positive respectively and that of Priya and her husband Haresh (donor) were A positive and B positive respectively. Both donors' blood groups did not match their own recipients' but they were suitable for the other ones.

"Dike was detected with advanced liver failure five months after his birth. His family flew down to SGRH in February 2009 for treatment.

"Immediate remedy could not be chalked out. Dike's father was not medically fit to donate," Neelam Mohan, pediatric hepatologist at SGRH said adding, "only a cadaver donor could be of help."

Meanwhile, Ahuja, who was admitted to the hospital in March 2009, was also detected with advanced liver failure three months later.

"Since both were struggling with their lives due to terminal liver failure and with no cadaver donor and living donors' liver not fit for them, the idea of swapping donors struck us, " Soin said.

"The biggest challenge in paired donation transplants is that both transplants must take place simultaneously, otherwise the donor for the second transplant may refuse to undergo surgery once his own loved one has received the donated organ," Soin said.

Sanjiv Saigal, the Transplant Hepatologist in charge of Priya's case said: "This opens up unique opportunities for matchmaking between donors and recipients from different families, thus helping save more lives with liver transplants."

Priya's husband was said to have donated 20 per cent of his liver to Dike while the child's mother donated 50 per cent of her liver to save Priya.

Interestingly, swapping is still not officially allowed in India. The team of doctors at Gangaram hospital, who conducted the swap did take the approval from an in-house regulatory body before going ahead. "It was the only way to save Dike and Priya. Three members on the committee are from the government," said a doctor.

India has been planning to launch a national organ transplant programme. The health ministry had drafted changes in the Transplantation of Human Organs Act, 1994 under which swapping of vital organs between willing but incompatible donors was to become legal.

The current rule restricts organ transplant to between blood relatives (father, mother, son, daughter, wife, husband, sister and brother), near and distant relatives and those having love and affection towards the patient.

Swapping will help patients who have relatives willing to donate but are medically incompatible for the recipient.

Dr. Saigal said: "Encouraged by this case, we have instituted registration of patients with medically suitable family donors who do not match their own recipients due to inappropriate blood group or liver size. This opens up unique opportunities for matchmaking between donors and recipients from different families, thus helping save more lives with liver transplants."

Dr. B.K. Rao, chairman of Ganga Ram Hospital added: "This swap transplantation will come as a blessing at the time of acute organ donor shortage. Around 30 per cent of rejected donors can become suitable swap donors, increasing transplant rates by 30 per cent."

India at present requires 30,000 liver transplants a year. Unfortunately due to the country's abysmally low cadaver donation, doctors end up carrying out about 400-odd transplants a year.