16 People, 8 Kidneys, One 'Domino' Transplant

Doctors completed the first ever eight-way "domino" kidney transplant — involving eight donors and eight recipients — this week.

The surgeries were performed in four hospitals over three weeks, and they all started with a man from Virginia who called Johns Hopkins Hospital offering to donate a kidney.

"The way the domino works is that you have an individual who does not have a designated recipient. In this case it was Thomas Koontz, who basically said, 'I'll donate my kidney to anyone who needs it.' And so he gave his kidney to a patient whose sister had wanted to give a kidney to her but was unable to because they were incompatible," says Dr. Robert Montgomery, director of the Johns Hopkins Comprehensive Transplant Center, who coordinated the kidney exchange.

"And so Thomas essentially starts the dominoes falling. So Thomas gave his kidney to that patient and then that patient's sister gave a kidney to another patient who also had an incompatible donor, and you can see then that this sets up a chain reaction," he says.

Most of the surgeries were performed at Johns Hopkins in Baltimore, but others took place in St. Louis, Oklahoma City and Detroit.

"The kidneys were shuttled between the hospitals in both commercial airliners and charter airliners," Montgomery says.

He says Johns Hopkins has been doing "domino" donations for about six years internally, but it only recently began including patients from other hospitals.

"Generally speaking, live-donor kidney transplants, at least up until this point, have had the donor and the recipient at the same hospital — and, in fact, often in adjoining rooms — and the kidney comes out of the donor and is immediately transplanted into the recipient," he says. "Now, we looked at the database and what we found was that there didn't seem to be any effect if the kidney had only been outside of the body for an hour or as long as eight hours."

Montgomery says it's not as hard as it might seem to keep track of a long chain of donors. "We have a system of multiple people checking the facts and the data over and over again," he says.

And all the patients are doing well, he says. "The kidneys seem to be quite happy in their new home."

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