Johns Hopkins team performs five-way donor kidney swap

Surgical teams at Johns Hopkins have successfully completed the first five-way donor kidney swap among 10 individuals. All five organ recipients are fine, as are the five donors, the surgeons reported.

Using a previously developed living donor matching system, the Hopkins transplant team was able to arrange a five-way swap in which all candidates received compatible kidneys from someone they had never met.

In a paper published in The Lancet (2006; 368:419-21), Robert Montgomery, MD, of Johns Hopkins, laid out the blueprint for a wider system of pairing altruistic donors and incompatible recipient pairs to greatly increase the number of available organs and to better serve the interests of both transplant donors and recipients.

Without a universal system of this kind in place, Dr. Montgomery said altruistic donors often end up on an Internet donation site or are subject to inconsistent allocation systems in which only a single patient benefits.

“With domino-paired donation, all three of these ethical tenets are satisfied,” Dr. Montgomery said. “The likelihood of a good outcome is increased by spreading the risk of recipient graft loss across more people. The neediest are served since, in many cases, incompatible donor-recipient pools have a high proportion of patients who are hard to match. And fairness is served because the last paired donor’s kidney in the chain is allocated to the next compatible patient on the deceased donor waiting list.”