Written by Insharah KhanA few months ago, as most teenagers his age were waiting anxiously for college admission lists and planning the next phase of their lives, 18-year-old Ali Raza was preparing for something else entirely. He was getting ready to donate a kidney. The recipient was not a stranger. It was his father.When doctors told Abid Raza, 49, that both his kidneys had failed and that a transplant offered his best chance of returning to a normal life, the family searched for a donor among themselves, hoping someone would match. No one did. Ali, the youngest son, was the only one who passed muster as a donor. “I was his only hope and I didn’t think twice about turning a donor to save his life. He had got me into the world and I chose to give something back to him. But there was another hurdle. We did not have the same blood group, making it what doctors call an ABO-incompatible transplant — a procedure that requires significantly more preparation than a standard kidney transplant,” says Ali.Beyond a perfect matchDr Paresh Jain, senior director, Urology and Kidney Transplant Surgery at Max Super Speciality Hospital, Patparganj, who led the transplant team, says two things made the case unusual: the blood group mismatch and the fact that Abid’s kidney failure stemmed from a rare autoimmune disease rather than more common causes such as diabetes or hypertension. Together, those factors meant the transplant team had to plan every stage carefully.“For decades, a mismatch in blood groups often meant transplantation was not an option within a family. Today, advances in transplant medicine are changing that. The purpose of highlighting cases like this is to ensure that people don’t think only matched transplants are possible,” says Dr Jain. “ABO-incompatible and even HLA-incompatible transplants (where the recipient’s immune system is already prepared to fight the donor organ, but doctors go ahead with the transplant anyway because they have ways to override that risk) are being done successfully now. Families should know these options exist,” he says.The implications are significant. Many patients with end-stage kidney disease struggle to find a donor because blood groups or tissue types do not match. These procedures allow doctors to widen the donor pool, giving patients access to organs that would previously have been ruled out. To reduce the risk of donor organ rejection, doctors used plasmapheresis, a procedure that removes specific antibodies from the recipient’s blood before surgery. “Plasmapheresis is the filtering of antibodies from the recipient’s blood, to make the recipient fit to undergo ABO-incompatible transplant,” Dr Jain explains. Such patients are also started on a more intensive immunosuppressive regimen than recipients of compatible transplants.The age factor of the donorThe medical complexity of the transplant was matched by another unusual factor: Ali’s age. At 18, he had just completed his Class XII examinations and was waiting to begin college. “National transplant guidelines permit kidney donation from the age of 18 but donors between 18 and 21 years are examined with particular caution,” explains Dr Jain. Before doctors approved Ali as a donor, they carried out an extensive evaluation to ensure he would remain healthy with a single kidney. He underwent a CT renal angiogram, which creates detailed three-dimensional images of the kidneys and the blood vessels supplying them. The test allows surgeons to study the anatomy carefully and determine which kidney is better suited for donation. He also underwent a DTPA scan, a nuclear medicine test that measures how much each kidney contributes individually to overall kidney function.Story continues below this ad“We have to know the split function — how much the right kidney is doing and how much the left kidney is doing. A creatinine test only gives an overall picture. When we’re evaluating a donor, we need to know exactly how each kidney is performing, so that the donor keeps the better kidney and the remaining one is strong enough to support him for the rest of his life,” says Dr Jain. That consideration becomes even more important in younger donors.Ali is expected to live for many decades with one kidney. The aim of the evaluation, doctors say, is to ensure that the kidney he retains can comfortably support a full and normal life while the donated kidney offers the maximum benefit to the recipient.Life after surgeryThe surgery was successful. Ali was discharged from the hospital after four days. Before the operation, he loved sports and physical activity. For now, those activities are on hold while his body heals. “I cannot do them but I have learnt to value my body more and now know how responsible I will have to be for it,” he says. Doctors typically advise donors to avoid strenuous exercise and contact sports for several weeks after surgery to allow the body to heal fully.Abid, meanwhile, says the change has been immediate. “I can feel the improvement inside my body after the transplant,” he says. For now, he remains largely indoors, avoiding crowds and outside food while the immunosuppressive medicines settle into a carefully calibrated routine. Doctors have advised him to stay home for three to four months and stick to home-cooked meals while his immune system remains deliberately suppressed to prevent his body from rejecting the transplanted kidney.Story continues below this adAli, too, is looking ahead. “Once fully recovered, I hope to take up B.Sc in Computer Science. My life has not stopped because of what I gave away. If anything, it has simply taken a different shape,” he says.Dr Jain says these days transplant medicine offers multiple options. “An 18-year-old can donate, and he is assured of leading a normal life with a single kidney. Incompatible donors become compatible. Ali will probably remember this Father’s Day differently from most people his age. Because he chose to gift his dad a second life,” he adds.