Thanks to the country's first pay-it-forward exchange of organs from Toronto, Edmonton and Vancouver has enabled four Canadians to acquire new kidneys.

Based on the idea of group co-operation, living-donor kidney swaps are about donors whose kidneys incompatible with those of a loved one, and needing a new kidney agrees to donate to a stranger, in exchange for a partner receiving a kidney from someone else.

While, Toronto has seen simultaneous kidney swaps before, however, this multi-city swap was carefully co-ordinated across three time zones.

With timing the key to such swaps, once a patient receives a kidney, it is possible their partner may rescind on the offer to donate, or a donor or recipient may back out after falling sick. Which is why, last-minute problems were avoided in this case, by all donors anaesthetised at the same time, and surgeons only started the donor operations after confirming telephonically they were ready to begin.

In this case, with over 50-medical personnel involved, donors travelled to where the recipients were i. e. two to Toronto General Hospital, one to Edmonton's University of Alberta Hospital, and another to Vancouver's St. Paul's Hospital.

Kidneys can also be flown between cities, as the organs remain viable for 12-hours after donation.

Cole, Head, University Health Network's kidney transplant programme in Toronto says, for some patients with severe kidney failure, a donation from a live donor offers better and faster results than transplants from deceased donors.

According to the Canadian Organ Replacement Register (CORR), about 35,000-Canadians suffer from kidney disease, while 3,000 of them are on waiting lists for a transplant.

Studies show kidney transplants conducted through paired donations save the healthcare system an average of $1-million per transplant, in comparison with the costs of keeping a patient on long-term kidney dialysis.