After ten years of research, scientists are nearing a breakthrough in transplanting kidneys between donors and recipients with different blood types. If this method proves effective, it could dramatically shorten waiting times and potentially save many lives.
Type O kidney patients are usually limited to type O donors, creating high demand as over half of waitlisted patients are type O and their kidneys can serve others too.
Researchers in Canada and China have now developed a theoretical “universal kidney”—an organ that could be accepted by patients regardless of ABO blood type.
In a recent experiment, a test kidney survived and functioned for several days in a brain-dead recipient, whose family consented to the study.
First Human Model Yields Kidney Transplant Insights
“This is the first time this has been demonstrated in a human model,” says Stephen Withers, a biochemist at the University of British Columbia. “It provides crucial insight into improving long-term transplant outcomes.”
Cross-blood-type transplants exist, but current methods of “training” the immune system are complex, costly, and risky. It also generally requires a living donor, as the recipient must be prepared in advance.
In this study, researchers effectively transformed a type A kidney into a type O kidney using specialized enzymes identified in earlier work. These enzymes remove the sugar molecules (antigens) that define type A blood.
First Human Model Yields Kidney Transplant Insights
The team likens the enzymes to molecular “scissors”: by cutting portions of the type A antigen chains, the kidney is left free of ABO markers, mimicking type O characteristics.
“It’s like stripping red paint off a car to reveal a neutral layer underneath,” explains Withers. “Once that’s done, the immune system no longer recognizes the organ as foreign.”
However, significant challenges remain before testing the approach in living humans. By day three, type A antigens reappeared on the transplanted kidney, triggering an immune response.
Still, the reaction was milder than usual, and there were signs the body was attempting to tolerate the organ. Future work must uncover why antigens return and how to prevent it via enzyme, timing, or preservation adjustments. Ensuring that antigen removal does not harm tissue integrity or kidney function over the long term is also critical.
Ensuring Safe and Scalable Implementation Across Transplant Centers
Operational considerations are equally important. If the method requires specialized equipment, researchers must prove it can be safely and affordably replicated across centers.
In the U.S., 11 people die daily waiting for a kidney, mostly type O. Scientists are exploring pig kidneys and new antibodies to expand organ availability and save lives.
In Brazil, improving ABO compatibility could boost transplant efficiency if paired with clear protocols, robust validation, and measures to prevent increased inequities.
“This is what happens when years of basic science finally connect to patient care,” says Withers. “Seeing our findings approach real-world impact is what keeps us motivated.”
The research was published in a biomedical engineering journal from the Nature group.
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