Surgical teams at Johns Hopkins have performed what is
believed to be the first six-way donor
kidney swap among 12 individuals. The 10-hour surgeries on
April 5 used six operating rooms and
occupied nine surgical teams at The Johns Hopkins
Hospital.
All donors and recipients are doing well and
recovering at the hospital.
The surgeries were set into motion when five
transplant candidates visited Johns Hopkins for
evaluation, each with a willing donor whose blood or tissue
types were incompatible. Using a Johns
Hopkins-developed living donor matching system, the
transplant team introduced into the mix a so-
called altruistic donor — one who volunteers a kidney
to no particular recipient — and were able to
arrange a six-way swap. This allowed all five original
candidates to receive compatible kidneys from
someone they had never met, while the remaining kidney went
to the next patient on the United
Network for Organ Sharing's recipient list.
The Johns Hopkins transplant team pioneered the
exchange of kidneys among incompatible
donor-recipient pairs — a procedure called kidney
paired donation. Johns Hopkins performed the first
KPD triple transplant in 2003, the first triple domino
transplant in 2005 and the first five-way domino
transplant in 2006. In a paper published in August 2007 in
the British journal Lancet, Robert
Montgomery, chief of the
Transplant Division at JHH, and a team of Johns Hopkins
researchers laid
out the blueprint for a wider system of pairing altruistic
donors and incompatible recipient pairs to
greatly increase the number of available organs and better
serve the interests of both transplant
donors and recipients.
Without a universal system of this kind in place,
Montgomery says, altruistic donors often end
up on an Internet donation site or are subject to
inconsistent allocation systems in which only a single
patient benefits. For example, in some cases, the kidney
goes to a patient deemed to have the best
chance for long-term survival, while in others, the organ
is given to a patient in greatest need or to
someone at the top of the UNOS waiting list regardless of
predicted outcome or need.
"With domino paired donation, all three of these
ethical tenets are satisfied," Montgomery said.
"The likelihood of a good outcome is increased by spreading
the risk of recipient graft loss across
more people. The neediest are served, since in many cases
incompatible donor-recipient pools have a
high proportion of patients who are hard to match. And
fairness is served because the last paired
donor's kidney in the chain is allocated to the next
compatible patient on the deceased donor waiting
list."
In the recent procedure, the six donor surgeries began
simultaneously. The kidneys remained in
the operating rooms, which were then sterilized and readied
for the intended recipients.
The donors will be monitored for the remainder of
their lives to make sure their remaining
kidney continues to function properly. The recipients will
be evaluated weekly for the first six weeks,
then monthly, with the frequency of hospital visits slowly
tapering off. The average expected life of a
live donor kidney is 18 to 20 years.
Nearly 100 medical professionals were required to make
this complex series of transplants
possible, 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.
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