April 9, 2008 in Nation/World

Baltimore patients recovering after first 6-way kidney swap

Jonathan Bor Baltimore Sun
 

BALTIMORE – Six kidney patients at Johns Hopkins Hospital received new organs from six unrelated living donors Saturday in what the chief surgeon called the nation’s first six-way “domino” kidney swap.

Nearly 100 medical professionals took part in the transplants, which began simultaneously in different operating rooms and stretched over 13 hours.

All 12 donors and recipients were listed in good condition Tuesday, a hospital spokesman said. Some had gone home while others were still recovering in the hospital.

Such swaps accommodate pairs of donors and recipients whose blood and tissue types don’t match each other but might match others in the same predicament. The closer the match, the more likely the recipient’s body is to accept the kidney. For the patients involved, paired swaps can shorten the time spent waiting for a transplant.

“It takes six people off the list and gives each the best possible kidney – a live kidney – and allows six other people to advance on the list,” said Dr. Robert Montgomery, chief of transplant surgery at Johns Hopkins.

There have been 301 matched kidney swaps in the United States since the early part of the decade, with the majority occurring between two pairs of donors and recipients, according to the United Network for Organ Sharing.

Johns Hopkins has performed 52 paired kidney exchanges, according to UNOS – by far the largest number of any hospital in the country. Hopkins pioneered the first triple swap in 2003 and the first five-way swap in 2006.

Montgomery said a national system to bring mismatched pairs together “could add about 2,000 additional transplants a year, which would be a huge boost.” Saturday’s whirlwind day of surgery had its origins in the preceding months, when five patients in need of transplants came to Hopkins, each with a willing donor whose blood type didn’t match.

The Hopkins transplant team finally accommodated them by finding a sixth donor – someone willing to give to anyone – and then arranging swaps between donors and patients who didn’t know each other.

The arrangement left a sixth kidney that went to the first patient on the national waiting list maintained by UNOS.

The donors and recipients came from North Carolina, Michigan, Idaho, Massachusetts, California and Pennsylvania. The pairs included two married couples, two friends, two cousins and a parent and child.

One of the recipients was Jeanne Heise of Atherton, Calif., who had spent 3 1/2 years on the waiting list at Stanford University Hospital. Her husband, Randall Bolten, was a willing donor but didn’t match her blood and tissue.

From her hospital bed Tuesday, Heise said she hadn’t heard of swaps like these until a cousin sent her a newspaper article about Johns Hopkins’ five-way exchange. She and her husband, the brother of White House chief of staff Joshua B. Bolten, went to Johns Hopkins for an evaluation in August. The couple found out a week ago Saturday that the transplant was imminent.

“I was cautiously optimistic because there are so many people involved,” Heise said. “If someone gets sick or has a change of heart, the whole process falls apart.” But the operations occurred without delay.

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