3 hospitals join in 6-way kidney swap

The doctors at Johns Hopkins are getting used to dominoes.

In November 2006, surgeons at Johns Hopkins Hospital in Baltimore completed the first five-way kidney swap with 10 patients. The "domino donor" procedure was set in motion when an altruistic donor kidney was introduced with incompatible donor-recipient pairs, leading to the quintuple transplant. The remaining kidney went to a patient on the United Network for Organ Sharing recipient list.

The hospital then conducted a six-way donor kidney swap among 12 people in April 2008.

In February, Johns Hopkins performed what it believes is the first six-way, multihospital domino kidney transplant.

The complex effort was achieved by Johns Hopkins, Barnes-Jewish Hospital in St. Louis and Integris Baptist Medical Center in Oklahoma City. Exchanging kidneys among a group of incompatible donor-recipient pairs made it possible to give each recipient a compatible kidney. An altruistic donor and recipient on the UNOS waiting list started and ended the procedure.

"Essentially, what we do is we mix and match and find a compatible organ for those individuals from a pool of people who have this problem," Robert Montgomery, MD, PhD, chief transplant surgeon at Johns Hopkins, told reporters. "It's just like a line of dominoes. If they don't all tumble, the ones that are left at the end are still standing."

As part of the swap, Johns Hopkins flew one kidney to Integris Baptist, which flew one kidney to Barnes-Jewish. That hospital flew a kidney to Johns Hopkins.

On Feb. 14 at 7 a.m. Eastern time, 12 surgeries started at the hospitals. Four surgeons were at Johns Hopkins, three at Integris Baptist and two at Barnes-Jewish. About 100 medical professionals took part in the transplants, including nephrologists, critical care doctors, anesthesiologists, operating room nurses and pharmacists.

The surgeries were finished by 7 p.m., and all 12 patients were in good condition.

Doctors said the multihospital effort would serve as a blueprint for national matches that could result in about 1,500 more transplants each year.

"There are many institutions that do living donor transplants, but there are so many people on the waiting list," said Surendra Shenoy, MD, kidney transplant surgeon at Barnes-Jewish Hospital and Washington University in St. Louis School of Medicine. "Through this domino exchange, we want to set a national model."