For a long time, if you needed a kidney transplant but your donor had a different blood group, doctors had to say no. They were worried that your body would see the new kidney as an ‘enemy’ and attack it immediately. This left thousands of people waiting for years on dialysis, hoping for a perfect match that might never come.
But medicine has moved forward. Today, accepting a kidney from a different blood group is no longer a deal-breaker.
How doctors ‘clean’ the blood
For many years, blood group incompatibility between donor and recipient was seen as an absolute prohibition on the transplant of a kidney. This was due to the fact that the pre-formed anti-ABO antibodies that the recipient has would immediately cause a violent reaction against the blood group antigens of the donor’s kidney, causing graft failure (hyperacute rejection). Consequently, many recipients who had family members willing to donate were left waiting for years. Recent advances in transplant immunology have made it possible to change this situation.
ABO (Type A or Anthem) blood group system is the expression of A and B antigens on not just the red blood cell surface but also on the lining of blood vessels in transplanted organs. Therefore, when a recipient has antibodies that are against components that are expressed on the cell surface of the transplanted organ donor, they can cause a very large amount of injury to the transplanted organ when those antibodies attach to it (like in the case of a recipient with blood type O receiving a kidney from a donor with blood type A, etc.). In the past, this made it very dangerous to perform kidney transplants on recipients with incorrect-blood types.
Dr. Amit Goel, a senior transplant expert at Max Super Speciality Hospital, Gurugram, says this has changed everything for his patients.
Desensitization methods have changed how ABOi transplants are done. Following desensitization protocols using either plasmapheresis or immunoadsorption to eliminate anti-ABO antibodies in the circulation before surgery, targeted immunosuppressive therapies reduce antibody production, thereby decreasing the risk of acute rejection. In addition, there is accommodation; in this process, transplanted kidneys are exposed to circulating antibodies, adapt, and are able to resist immune-mediated damage over time.
“We used to have so many families where someone was desperate to donate a kidney, but we couldn’t proceed because the blood types didn’t match,” says Dr. Amit Goel. “Now, we can tell them that the mismatch isn’t a dead end. With the right prep work, these transplants are very successful and let people get back to their normal lives much faster,” he further added.
What the research shows
You might wonder if these mismatched kidneys last as long as a perfect match. The data says they do. According to a study published in 2024 in The Lancet Regional Health, patients who get these transplants actually have a much better survival rate than those who stay on dialysis waiting for a perfect donor.
Another major report published in 2024 in the journal Frontiers in Immunology found that after the first few weeks, a mismatched kidney works just as well as any other. Over the long term, the body actually adapts to the new kidney, a process doctors call accommodation. This means the risk of rejection drops significantly as time goes on.
One of the biggest medical breakthrough
The biggest benefit of this medical breakthrough is time. Instead of waiting five or ten years for a deceased donor, patients can often get a transplant within weeks if they have a willing family member, even if their blood types are different.
As Dr. Amit Goel explains, “The goal is to get you off a dialysis machine and back to your family. We now have the tools to make that happen, regardless of your blood group.”
If you or someone you love has been told a transplant isn’t possible because of a blood mismatch, it’s worth asking for a second opinion. The ‘impossible’ transplant is now happening every day.