Doctors Perform Historic Five-Way Kidney Swap

Surgical teams at Johns Hopkins Hospital in Baltimore performed a "domino-effect" cascade of kidney transplants, transferring organs from five healthy individuals into five patients in need of kidneys in one massive operation last week.

The procedure, known as kidney paired donation, or KPD, took place Nov. 14 and was announced today. The five-way operation -- the largest such procedure to date -- lasted 10 hours and combined the efforts of a dozen surgeons, 11 anesthesiologists and 18 nurses working in six operating rooms.

The operation carries hope for expanding available donor options in a system swamped with those in need of a kidney.

According to statistics from the United Network for Organ Sharing, 68,934 patients in the United States are currently on the waiting list for donated kidneys. Because of a shortage of donors, 3,886 patients -- more than 10 a day -- died in 2004 while waiting for a kidney, according to statistics compiled by the National Kidney Foundation.

Experts said chain-reaction surgeries like this one could help solve the problem.

"This represents a significant step in advancing our ability to identify living kidney donors for potential transplant recipients," said Dr. Bryan Becker, section chief of nephrology at the University of Wisconsin-Madison. "This also demonstrates a significant institutional commitment from Johns Hopkins to align the necessary resources to do this."

"I think this operation testifies to the need to be creative about our approaches when it comes to organ donation," said Dr. David Axelrod, surgical director of transplants at Dartmouth Medical School in Hanover, N.H. "It's an example of how we can use altruistic donations to maximize the benefit to the recipient community."

Making the Most out of an Altruistic Act

The chain reaction of surgeries was set off by one "altruistic" donor, Honore Rothstein. The healthy 48-year-old woman said she was motivated to donate a kidney after losing both her husband and her daughter in separate accidents and illnesses.

Rothstein donated her kidney to Kristine Jantzi, 40, who'd had end-stage renal disease since age 10. Jantzi's 65-year-old mother, Florence, in turn, donated one of her kidneys to 52-year-old George Lonnie Brooks.

Brooks' wife, Sharon, 55, donated one of hers to 61-year-old Gary Persell. Persell's wife, Leslie, 61, gave one of her kidneys to 77-year-old Gerald Loevner.

The final link in the chain is Loevner's wife, Sandra, 63, who donated one of her kidneys to Sheila Thornton, also 63, who had been on the United Network for Organ Sharing's waiting list.

"It has been a privilege to help Ms. Rothstein fully realize her altruism by placing her into a domino transplant where her gift has made five transplants possible that would not have occurred," Robert Montgomery, director of the incompatible kidney transplant program at Johns Hopkins said in a statement.

According to a press release issued by Johns Hopkins, all the organ recipients and donors recovered and were scheduled for release today.

Compatible Organs Hard to Find

Kidney transplants are nothing new; the first successful such operation took place in 1954. But compatibility has always posed difficulties.

Tuesday's operation showcased advancements in finding matches for difficult cases. In the five-way swap, all four original candidates received compatible kidneys from someone they'd never met, and the remaining kidney went to a patient who was next on the United Network's organ recipient list.

Johns Hopkins, a pioneer in the exchange of kidneys between incompatible donor-recipient pairs, performed the first nondomino kidney paired donation transplant in the United States in 2001, the first nondomino KPD triple transplant in 2003, and the first triple domino transplant in 2005. To date, its surgeons have transplanted 41 patients in KPD operations.

Axelrod said the participation of donors in operations like this one showed a degree of trust in the system.

"It is a remarkable leap of faith for the recipient and donor pairs in these domino operations," he said. "In general, with these procedures, the donor will know the person they are doing it for, so their willingness in large part depends on their relationship with the person getting the organ."

The operation also showed how the impact of one act of altruism could be extended to help many more patients than before.

"This form of organ donation is increasing across the country," Becker said. "Many large transplant centers are willing to evaluate individuals who wish to be considered as altruistic donors. For these individuals, this is an opportunity to aid in another life and fulfill some of the true tenets of altruism.

"This is a tremendous act, more than a gesture, and such individuals should be honored for their commitment towards healing."