Northwestern Memorial Successfully Completes Rare Four-Way Domino Paired Kidney Exchange Transplant Surgery
Four kidney donors and four recipients simultaneously underwent surgery
On Thursday, April 3, transplant surgeons at Northwestern Memorial Hospital successfully completed a rare procedure known as a four-way domino paired kidney exchange involving a total of eight patients. The surgery is among the nation’s largest paired exchanges and involved four kidney donors and four recipients who underwent simultaneous transplant surgery. The donors were two women and two men, as were the recipients. All are recovering well following surgery, which involved a total of 32 clinicians—six of them surgeons—working between four operating rooms and took more than 10 hours to complete.
“This is a landmark surgery for our transplant team,” said Joseph Leventhal, MD, PhD, transplant surgeon and director of the living donor kidney transplant program at Northwestern Memorial. “We are excited to have coordinated and successfully completed the region’s first four-way exchange, and the largest paired exchange to ever occur at our hospital.”
Northwestern Memorial’s transplant team had previously performed what’s known as a two-way paired exchange. This type of transplant is made possible when a kidney donor and their intended recipient are incompatible, but are matched with another donor and recipient in the same situation. But even paired kidney exchanges involving four patients are incredibly rare due to numerous compatibility requirements including blood type matching, tissue matching and crossmatching.
Events leading to last Thursday’s “domino” exchange began to unfold when three transplant candidates came to Northwestern Memorial with donors, but all pairs discovered they were incompatible after testing. Simultaneous to these events, a Good Samaritan who always intended to be a living donor presented himself to the hospital’s transplant program and offered one of his kidneys to whoever was in the greatest need. Unbeknownst to him, his act of kindness was the catalyst that set off a chain of compatibility for several recipients, because by adding a fourth transplant candidate who was at the top of the United Network for Organ Sharing (UNOS) organ recipient list the transplant team was able to arrange a four-way swap using a living donor matching system. In effect, all four recipients ultimately received compatible kidneys, but they were from donors they had never met.
“More than one-third of living kidney donor-recipient pairs are not compatible,” said John Friedewald, MD, transplant nephrologist at Northwestern Memorial. “Paired exchange programs have the potential to dramatically increase the number of patients that receive transplants and reduce time spent on the waiting list.”
Thursday’s surgery crossed ethnic, gender, racial and language lines and brought together eight individuals that otherwise would never have met, but now are connected for life. Patients ranged in age from 25-65 years and hailed from Chicago and neighboring suburbs, Washington D.C, and Puerto Rico.
“The diverse patient population that we transplanted in this four-way exchange speaks to the larger transplant community and the potential for individuals, regardless of background, to come together in order to donate life by helping others receive the organs they need,” said Dr. Leventhal.
Doug Penrod, the Good Samaritan, or altruistic donor, is a Northwestern Memorial employee and 17-year member of the transplant team. He decided to donate his kidney blindly after his intentions to donate to a friend fell through. “After agreeing to donate my kidney once, and then not being able to, I felt I should still go through with the surgery and help out someone else in need,” commented Penrod. “I’ve seen firsthand the good a transplant can do, and I know the risks to the donor are very minimal in both the short and long term. It was the right thing to do.”
One of the recipients, Pierre Kattar Sr., reflected on his surgery, “After waiting so long, I’m thankful to have finally received a kidney.” Kattar Sr. unsuccessfully tried to find a kidney match three times prior to Thursday’s surgery. “Dialysis is draining, I felt washed out after every session and had no quality of life,” he added.
Another recipient, Niral Patel, was incompatible with his donor due to a positive crossmatch. Northwestern Memorial is one of two hospitals in Illinois and only a handful nationwide that offer the capability to transplant ABO, blood type incompatible, or crossmatch incompatible donors and recipients. Transplant physicians desensitized Patel’s blood before the transplant took place through a process called plasmapheresis, which cleans the antibodies in the blood so they do not attack the new kidney after the surgery. Patel went through several plasmapheresis treatments in the weeks preceding surgery, as well as additional treatments afterwards to ensure that the transplanted organ is not rejected. “I was able to find a kidney, and it took seven other people coming together to make this happen. It’s clearly a miracle,” commented Patel after the surgery.
“We are proud to have achieved this milestone and are committed to building our paired exchange program further,” said Michael Abecassis, MD, MBA, chief of the division of organ transplantation at Northwestern Memorial Hospital. “These programs provide more options for those in need of a transplant, which means more lives saved.”