Emergency Information Take Over

School of Medicine Faculty Surgeons Perform Four-Way Kidney Transplant Surgery on Patients From Four Different States

Tuesday, November 10, 2009

 Stephen T. Bartlett, M.D., professor and chair of the Department of Surgery, performed two of the transplants.

Living donors had a kidney removed through an opening in the belly button; One of the recipients was a 10-year-old boy from the Baltimore area

Transplant surgeons at the University of Maryland Medical Center have successfully completed a four-way kidney exchange involving eight patients from four states. The youngest recipient is a 10-year-old Catonsville, Md., boy, and the oldest a 74-year-old man from Virginia Beach, Va.

All four of the living donors had a kidney removed through a single incision through their navel, which speeds recovery and leaves virtually no scar. University of Maryland surgeons have performed more of these single-incision laparoscopic surgeries than any hospital in the country, but this is the first time that the technique has been used in a multiple kidney exchange. All of the donors and recipients are recovering well following the surgeries, which took place on Nov. 2 and Nov. 3, 2009, at the University of Maryland Medical Center.

Stephen T. Bartlett, M.D., surgeon-in-chief at the University of Maryland Medical Center and professor and chairman of surgery at the University of Maryland School of Medicine, who performed two of the transplants, says, “This large living donor kidney exchange requires extensive planning and coordination, but it provides great benefits to people with kidney failure who do not have a compatible living donor. We’ve been a national leader in kidney transplantation and laparoscopic donor kidney removal for many years, and our singular focus has always been on providing the highest quality care and the best outcomes for patients. This is yet another significant advance that will benefit patients from Maryland and throughout the country.”

Kidney exchanges, or swaps as they are sometimes called, allow living donors and their intended recipients to proceed with surgery, even if their blood and tissue types don’t match. They are paired with other donors and recipients who are incompatible with each other but are a match with others in the group. The patients are from Maryland, Virginia, Massachusetts and Florida. Two of the donors are female, and the other two donors and all of the recipients are male. There is one married couple, but the wife was not a match for her husband.

“Four people who otherwise would not have had matching donors now have lifesaving kidneys – from people they’ve never met. And this transplant chain was set in motion by a man who simply wanted to donate a kidney to someone in need,” says Matthew Cooper, M.D., director of kidney transplantation at the University of Maryland Medical Center and associate professor of surgery at the University of Maryland School of Medicine, who oversaw the series of surgeries.

Only a handful of hospitals in the country have performed large kidney transplant exchanges such as this one. The procedures, which took place over two days in four operating suites at the medical center, required extensive coordination and planning not only in the operating rooms, but also in the waiting rooms. Because the right to privacy for the donors and recipients is protected throughout the process, transplant coordinator Debbie Iacovino arranged separate waiting areas in different parts of the hospital for their families to ensure anonymity.

The kidney exchange started with a 59-year-old man from a suburb of Boston, Mass., who offered to donate a kidney to someone in need. His kidney was given to a Maryland man who was not a match with his intended donor, a woman who is also from Maryland. The woman was matched with a 10-year-boy from Catonsville whose kidneys were failing because of a congenital abnormality. A friend of the boy’s family, a 50-year-old lawyer from Catonsville, gave his kidney to a 64-year-old Florida man, whose wife was a donor for 74-year-old man from Virginia Beach, Va. The Virginia man’s son-in-law will be a “bridge” donor, who will give his kidney to a yet-undetermined recipient at a later date, which will allow the chain of transplants to continue.

Edward Behn, of Westborough, Mass., who started off the chain of transplants, says it didn’t matter to him who received his kidney. “Do your good turn,” he added, referring to the slogan, “Do a good turn daily,” used by the Boy Scouts of America, a group with whom he has been actively involved for many years.

About one third of patients who have a relative or friend willing to donate are not able to receive the kidney because of blood type or tissue-type incompatibility. Kidney exchanges increase the pool of donors and allow incompatible pairs to be matched with other pairs in the same situation.

Benjamin Philosophe, M.D., Ph.D., director of the Division of Transplantation at the University of Maryland Medical Center and associate professor of surgery at the University of Maryland School of Medicine, notes that patients who receive kidneys transplanted from living donors fare better than those who receive kidneys from deceased donors.

“There is a significant difference in outcomes with living-donor kidney transplants. There is also a severe shortage of kidneys from deceased donors, with people waiting three to five years to get a kidney. So, living donor transplants are often the best option for patients. With these types of kidney exchanges, we can dramatically increase the availability of donor kidneys and help many more people who need a transplant,” Dr. Philosophe says. More than 82,000 people waiting for kidneys are on the official list maintained by the United Network for Organ Sharing (UNOS). Last year, 16,517 received transplants – 5,967 from living donors.

E. Albert Reece, M.D., Ph.D., M.B.A., vice president for medical affairs at the University of Maryland and dean of the University of Maryland School of Medicine, says, “Our physicians are always working to develop better and more innovative ways to help patients, and this four-way kidney exchange is another example of that diligence and excellent work. I congratulate Dr. Bartlett and the entire transplant team for this wonderful achievement.”

Jeffrey A. Rivest, president and chief executive officer of the University of Maryland Medical Center, notes, “The University of Maryland Medical Center has performed the largest number of minimally invasive kidney removals of any hospital in the world, starting in March 1996 and passing the 1,000 patient mark in 2005. These delicate, complicated surgeries demonstrate the tremendous expertise of our medical staff, nurses and technicians.”

“Providing anesthesia for patients undergoing transplantation is challenging because of the nature of the surgery and the medical condition of the patients. We work closely with our surgical colleagues to ensure the safest care and highest quality outcomes," says Peter Rock, M.D., chief of Anesthesiology at the University of Maryland Medical Center and professor and chairman of Anesthesiology at the University of Maryland School of Medicine. He adds, "We are excited to have played a key role in these kidney transplants in order to improve the lives of the kidney recipients."

In April 2009, University of Maryland surgeons began to remove donor kidneys through an opening in the navel, becoming the first hospital in Maryland and only the third hospital in the United States to use this approach. Since then, about 30 of these single-incision surgeries have been performed at the University of Maryland Medical Center. In the procedure, surgeons insert a camera and two instruments into the specially designed port in order to separate the kidney from its attachments in the abdomen. The kidney is removed through the same opening, which is covered with a tiny bandage. Donors are discharged within a day or two.

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Karen Warmkessel
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 How the Swap Worked

 Surgeons bring new life to one of the recipients.

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