Introduction: Long kidney exchange chains are routinely performed in developed world due to established multicentre, National program and use of computer allocation. There is data scarcity of challenges and solution for long kidney exchange chain in developing world.

Methods: This is a single center cohort study of non-simultaneous kidney exchange cycles in 10 donor-recipient pairs (DRPs).  Alliance for Paired Donations kidney exchange software was used for DRP non-anonymous allocation. We report our experience and discuss challenges and solution.

Results: To overcome limited surgical capacity, two transplant surgeries were performed each on 4th, 6 th and 7 th January, 3 transplants on 8 th January and last kidney transplant was completed on 22 th January 2020 which was delayed due to chest infection. All patients have good outcome after transplants and normal kidney graft function without any delayed graft function, rejection, medical and surgical complications. Three bridge donors were trusted to donate after their recipients have received the kidney. There is no donor renege or chain collapse.

Conclusions: Kidney exchange is bureaucratically complex but medically straightforward. We report longest single centre kidney exchange transplant chain of 10 DRP in India and Asia without donor renege. This is an impressive feat that shows how teamwork and innovation can achieve miraculous results. Implementation of this success on a State/ National level may further increases access to kidney transplant for incompatible pairs.