A collaborative effort between San Francisco UCSF and California Pacific MC saw a 9-way kidney swap transplantation operation extending over 2 days.

(Left to right) Dr Andrew Posselt and Shyam Raghavan, third year resident, perform surgery to remove the kidney of a donor at UCSF Medical Center at Parnassus in San Francisco, California. CREDITS: Lea Suzuki, The Chronicler.

University of California at San Francisco and California Pacific Medical Centre collaborated together in a 9-way kidney transplant swap over a period of 36 hours which included the kidneys being exchanged between hospitals as well. This is the longest chain of kidney transplantations done in a single city.

Both transplant centers usually compete with each other but on this occasion their collaboration paved the way for a one of a kind chain operation in one city in just 36 hours.

The process involved 18 patients with 9 donors and 9 recipients with six kidneys being sent from one hospital to the other. 8 of the surgeries were performed in UCSF while 10 took place at the California Pacific.

In the United States, people waiting for a kidney transplant have to wait either until a kidney becomes available at the hospital or until they find a matched donor. Even though everyone is born with two kidneys, finding a perfectly matched donor-recipient pair is the main issue.

Often even the closest family members cannot be the perfect match. Not only does the blood group come into play when matching donors, but the biggest problem is a group of proteins on the new organ which may trigger the recipient’s immune system to outright reject the new tissue, thus wasting the transplanted organ. Immuno-suppressive drugs are used to prevent tissue rejection.

Software matching programs are paving the way for such kidney transplant chains to occur. Both hospitals used BiologicTx paired donation kidney matching program known as MatchGrid. The program was developed by a San Francisco software expert David Jacobs after he himself underwent a kidney transplant in 2003 at California Pacific.

The software programs work by using blood types and medical data of the patients to match compatible people. This allows people who want to donate an organ to a loved one to be paired with a matching recipient if they are not compatible to the person they wish to donate to. Instead, another donor match is found for them and their loved one and the chain continues.

But all this starts with a person wanting to donate a kidney while expecting nothing in return. He is the “altruistic” donor.

Removing a kidney from a donor takes just over 1.5 hours. The kidney is then packaged carefully and transported to the operating room with the recipient who could either be in an adjacent room or even in another hospital. The longest chain kidney transplantation done in the US was a 34-way kidney swap, with 68 total surgeries conducted in 26 hospitals over a 3 month period.

Managing the logistics of such an operation is the key to success of the transplant. It is a finely balanced equation with the kidney being taken out of the donor and then being transplanted into the recipient. Fortunately organs like kidney and liver can stay out of the body for as long as 24 hours if conditions are kept optimal. More high risk is the transport of lungs and hearts as they require swift transplantation preferably within a few hours.

UCSF’s Director Dr Brian Lee explained that although a kidney swap could technically go on forever, it was best to limit the number of swaps conducted in one go. “You have so many logistical issues with so many people involved that all it takes is one break in the chain to negatively impact the entire outcome.”