Conquering immunological barrier- part 2: paired kidney exchange transplantation

ABO blood group or human leucocyte antigen (HLA) incompatibility remain major immunological barriers for organ transplantation. One strategic approach to conquer this barrier is desensitize the recipient yet it remains expensive, resource intensive with a higher risk of complications. Paired kidney exchange(PKE) is an alternative strategy, where an exchange of kidneys happens among pairs consisting of a recipient with a willing live donor, yet unmatched for the particular recipient, making transplant unfeasible. PKE has evolved in to many complex types since its introduction of concept in 1986. This review aims at discussing the types, global trends, challenges and ethical aspects of PKE transplantation.