Johns Hopkins Gazette | February 23, 2009
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The newspaper of The Johns Hopkins University February 23, 2009 | Vol. 38 No. 23
JH Leads First 12-Patient, Multicenter 'Domino' Kidney Swap

By Eric Vohr
Johns Hopkins Medicine

Surgical teams at The Johns Hopkins Hospital, Barnes-Jewish Hospital in St. Louis and Integris Baptist Medical Center in Oklahoma City on Feb. 14 successfully completed the first six-way, multihospital, domino kidney transplant.

All six donors (one man and five women) and six organ recipients (four men and two women) were in good condition following the surgery, according to Robert Montgomery, chief transplant surgeon at Johns Hopkins.

The procedure, called kidney paired donation or KPD, takes a group of incompatible donor- recipient pairs (recipients with a willing donor who is not compatible by blood or tissue) and matches them with other pairs in a similar predicament. By exchanging kidneys between the pairs, each recipient receives a compatible kidney from a stranger, and transplants are enabled that otherwise would not have taken place. Involving multiple hospitals creates even more possibilities for matches.

In this so-called domino swap, a surgical team made up of nine surgeons, six anesthesiologists and 12 nurses began a cross-country set of operations with five incompatible pairs; an altruistic donor and a recipient who was next on the United Network for Organ Sharing recipient list started and ended the domino. (Altruistic donors are those willing to donate a kidney to any needy recipient.)

Just like falling dominoes, the altruistic donor kidney went to a recipient from one of the incompatible pairs, that recipient's donor's kidney went to a recipient from a second pair and so on. The last remaining kidney from the final incompatible pair went to the UNOS recipient.

As part of this complex procedure, Johns Hopkins flew one kidney to Integris Baptist; Integris Baptist flew one to Barnes-Jewish, and Barnes-Jewish flew one to Johns Hopkins.

"We have performed a six-way domino procedure at our hospital before," Montgomery said. "But this is the first time we have done something this ambitious on such a grand scale involving two other hospitals. This will serve as a blueprint for national matches in which kidneys will be transported around the country, resulting in an estimated 1,500 additional transplants each year."

The 12 surgeries — all of which had to start at the same time — began at 7 a.m. EST. The surgeons in charge included four at Johns Hopkins, three at Integris Baptist and two at Barnes- Jewish. All finished by 7 p.m. EST.

Johns Hopkins surgeons performed one of the first KPD transplants in the United States, in 2001; the first triple-swap, in 2003; the first double and triple domino transplants, in 2005; the first five-way domino transplant, in 2006; and the first six-way domino transplant, in 2007. Johns Hopkins also performed the first multihospital, transcontinental three-way swap transplant, in 2007.

Taking part in the transplants were nearly 100 medical professionals, including immunogeneticists, anesthesiologists, operating room nurses, nephrologists, transfusion medicine physicians, critical care doctors, nurse coordinators, technicians, social workers, psychologists, pharmacists, financial coordinators and administrative support people.

The other surgeons who participated in the surgery were Mohamad Allaf, Andrew Singer and Dorry Segev of Johns Hopkins; Scott Samara, Shea Samara and William Miller of Integris Baptist Medical Center; and Surendra Shenoy and Martin Jendrisak of Barnes-Jewish Hospital.

This week, Johns Hopkins will launch a Web documentary about the procedure at


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