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MELISSA BLOCK, host:

It all started with a man from Virginia who called Johns Hopkins Hospital offering to donate a kidney. It turned into the first-ever eight-way domino kidney transplant: eight donors, eight recipients, with surgeries performed in four hospitals over three weeks.

Dr. Robert Montgomery coordinated the kidney exchange. He's director of the Johns Hopkins Comprehensive Transplant Center. Welcome to the program.

Dr. ROBERT MONTGOMERY (Director, Johns Hopkins Comprehensive Transplant Center): Thank you.

BLOCK: And Dr. Montgomery, why don't you explain how this domino donor chain works, starting with that first altruistic donor, Thomas Koontz.

Dr. MONTGOMERY: 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. And so, Thomas essentially starts the dominos 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.

BLOCK: Now, most of the surgeries that we're talking about in this domino kidney transplant were performed there at Johns Hopkins. Others, though, at hospitals in St. Louis, Oklahoma City and Detroit. How did you coordinate all this with these three other hospitals in three other cities?

Dr. MONTGOMERY: The kidneys were shuttled between the hospitals in both commercial airliners and charter airliners. So, it does involve a tremendous amount of coordination and a logistical support in order to pull something like this off.

Now, we've been doing these domino-paired donations for about six years, and we have been drawing from our single-center pool of incompatible donors and recipients. But in recent years, we've started to cross-pollinate. In other words, we have done computer match runs that have included patients from other hospitals, and that's how this came about.

BLOCK: How long can the kidneys be kept in between surgeries?

Dr. MONTGOMERY: 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.

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.

BLOCK: So, you still had to get those kidneys onto a plane and on their way pretty fast.

Dr. MONTGOMERY: Exactly.

BLOCK: Dr. Montgomery, somewhere in the middle of this chain, did you start getting confused and losing track of whose kidney was coming from whom and going to whom?

Dr. MONTGOMERY: Well, you know, it's sort of like keeping track of your children.

BLOCK: If you have a lot of children.

(Soundbite of laughter)

Dr. MONTGOMERY: You know, we pay attention to detail.

BLOCK: Well, I would hope so.

Dr. MONTGOMERY: So, we have a system of multiple people checking the facts and the data over and over again. It's really not quite as difficult to keep it all together as you might imagine.

BLOCK: Well, the last surgery in your chain was on July 6. How are the patients doing?

Dr. MONTGOMERY: Patients are doing well. All of our patients are doing well, and the kidneys seem to be quite happy in their new home.

BLOCK: These are happy kidneys, the kidneys are happy?

(Soundbite of laughter)

Dr. MONTGOMERY: They're all working well.

BLOCK: Well, Dr. Montgomery, thanks for talking with us.

Dr. MONTGOMERY: Oh, happy to do it.

BLOCK: That's Dr. Robert Montgomery, chief transplant surgeon at Johns Hopkins Hospital in Baltimore, talking about the first ever eight-way domino kidney transplant.

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