Successful Long-distance Deceased Donor Renal Transplantation Using a Commercial Airline: A Public-sector Experience from Kerala

Deceased donor renal transplantation remains the preferred renal replacement therapy for patients with end-stage kidney disease who lack a suitable live donor. However, its success is highly dependent on efficient organ retrieval, transport logistics, and timely immunological evaluation. Cold ischemia time remains a major modifiable determinant of delayed graft function and long-term allograft outcomes, particularly when the organs have to be shared across geographically distant centers. We describe a successful long-distance deceased donor kidney transplantation in Kerala, India, wherein the donor kidney was transported over approximately 500 km from Kannur to Government Medical College, Thiruvananthapuram, using a scheduled commercial airline within the public healthcare system. Strategic planning which included early recipient mobilization, centralized crossmatch testing at a centrally located transplant immunology laboratory, coordinated green corridor facilitation, and synchronization of surgical teams. Despite prolonged transport distance, the recipient demonstrated immediate graft function. This experience highlights the feasibility, safety, and cost-effectiveness of commercial airline-based organ transport and its potential role in strengthening deceased donor transplant programs in resource-limited public-sector settings.