6 transplant surgeons perform 16 surgeries over 3 days in landmark domino paired kidney exchange

Northwestern Memorial Performs Eight-Way Paired Kidney Exchange Transplant; Among Largest Single-Center Paired Exchanges in the United States

Chicago resident Maria Isho had been waiting for over nine years for a kidney transplant. Her body was highly sensitized, meaning that her body had built up antibodies in the blood, which made it difficult for her to find a match. To stay healthy, she endured a grueling dialysis regimen which diminished her quality of life and left her feeling physically drained. Just when it seemed that she would never get the transplant she so desperately needed, Isho received a call from Northwestern Memorial's Kovler Organ Transplantation Center saying they had found her a living donor, something that she and her husband consider "a miracle."

Isho soon learned that she would be part of a landmark transplant chain that would involve eight patients in need of a kidney transplant and an additional eight donors, for a total of 16 people.  Commonly referred to as a domino paired kidney exchange, or a closed-chain transplant, the surgery would be the largest of its kind performed at Northwestern Memorial, and among the largest single center paired exchange in the country.  

The 16 surgeries took place over the course of three days and required the efforts of six transplant surgeons as well as more than 40 additional clinical staff. The patients range in age from 26 to 67 years old, hail from four states and cross ethnic, gender, racial and language lines.

Joseph Leventhal, MD, PhD, director of the hospital's living donor kidney transplant program, said that increasingly patients are getting the message that at the end of the day, the most important thing is that their intended recipient gets a kidney. "We want living donor pairs to know that if they hear they aren't a match for one another, it isn't the end of the story," said Leventhal. "Centers like ours can offer other options for these patients to help their loved ones get the transplants they need."

"About one-third of living donors who come to Northwestern are incompatible with their intended recipient," said John Friedewald, MD, transplant nephrologist at Northwestern Memorial. "Paired exchanges are becoming more and more common, and hold great potential to expand the living donor pool."

Friedewald, who is also Chairman of the United Network for Organ Sharing (UNOS) committee on paired exchange, added that the organization plans to pilot a national program aimed to get more centers involved in paired exchanges.  

Northwestern transplant surgeons performed their first paired exchange in 2006, and have performed 25 paired exchange transplants to date. When living donors come to Northwestern Memorial, they are made aware of the option of a paired exchange. Members of the hospital's transplant team regularly comb through the database of donors and recipients to find pairs who are compatible with one another and contact potential matches to see if they would be willing to participate.

Multiple recipients that participated in this paired exchange including Isho, were difficult to match due to sensitization or other types of incompatibilities. 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 Isho's blood before the transplant through a process called plasmapheresis, which cleans the antibodies in the blood so they do not attack the new kidney after the surgery. Isho went through several plasmapheresis treatments in the weeks preceding surgery, and will undergo additional treatments following surgery to ensure that the transplanted organ is not rejected.  

"To think that a complete stranger stepped forward to initiate this chain is just remarkable," said Isho.  "I never lost faith, and I'm grateful to have a second chance."

Among the other patients involved were two Roman Catholic nuns, a father and daughter from Yorkville, Illinois, a sister and brother from Chicago, Illinois and a husband and wife from Champaign, Illinois.  

"This is an important milestone for the program, and we are happy to have brought these sixteen individuals together," said Leventhal. "We hope this transplant helps raise awareness of the powerful impact of the kindness of strangers and the importance of organ donation."