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July 7, 2009, ST. LOUIS - What is believed to be the largest multi-center domino kidney transplant in the US was completed Monday when surgeons at Barnes-Jewish Hospital removed a kidney from a southern Illinois woman and transported it to The Johns Hopkins Hospital in Baltimore to be transplanted into a waiting recipient.

This transplant closed a series of “paired kidney exchanges (PKE),” that began June 22 and involved 16 patients at four different transplant centers including Integris Baptist in Oklahoma City and Henry Ford Medical Center in Detroit, as well as Barnes-Jewish and Hopkins.

PKE matches a potential kidney recipient who has a willing donor whose blood or tissue does not match the recipient with a similar “mismatched” donor/recipient pair. The pairs exchange kidney donors so each recipient receives a compatible kidney. Comparing lists of mismatched donor/recipient lists at several transplant centers allows for more potential matches.

In this exchange, eight donors – five women and three men – donated kidneys to eight recipients – five women and three men – at the four hospitals over three different days. Doctors said all the patients were in good or satisfactory condition after the surgeries.

The domino procedure involving the three medical centers speaks to the lack of organ donors throughout the nation.

“There are many institutions that do living donor transplants, but there are so many people on the waiting list,” says Surendra Shenoy, MD, kidney transplant surgeon at Barnes-Jewish Hospital and Washington University School of Medicine. “Through this domino exchange, we want to set a national model.”

"This will serve as a blueprint for national match in which kidneys will be transported around the country resulting in an estimated 1,500 additional transplants each year," says Robert Montgomery, M.D., Ph.D., chief transplant surgeon at Johns Hopkins.

The first procedures were on June 22 with surgeries at Barnes-Jewish, Johns Hopkins, Integris Baptist and Henry Ford.

On that day at Barnes-Jewish, Mu Cha Leffler, 60, of Christopher, IL, received a kidney from a donor at Johns Hopkins. The operation on Leffler was peformed by Dr. Shenoy.

The donor kidney began working as soon as it was implanted into Leffler, according to Dr. Shenoy. She was discharged from Barnes-Jewish June 26.

Leffler, whose kidney failure was a complication of her battle with diabetes, had been on dialysis three times a week for two years. The dialysis treatments, though lifesaving, kept Leffler from fully enjoying her life, said her husband of 39 years, Dale.

“She’d be wiped out right after the treatment,” he said. “The next day she’d feel pretty good, but the morning after that, she’d feel bad again and it was time for treatment.”

She’s looking forward to spending time with her grandchildren and working in her garden again, Dale Leffler said.

In the July 6 procedure, Dr. Shenoy removed a kidney from donor Christine Hargis, 37, of Coello, IL. The kidney was packed in ice and flown by chartered jet to Baltimore, where it was transplanted at by surgeons at Hopkins.

Hargis, the daughter of Mu Cha and Dale Leffler, had intended to donate her kidney to her mother. But testing showed that they were not a blood antigen match. Antigens in Leffler’s blood also made it unlikely that she would ever find a matching cadaver donor, said Dr. Shenoy.

“It is unlikely that she would ever have found a cadaver donor,” said Dr. Shenoy. “Paired kidney exchange is the only way she could have a transplant.”

A matching donor for Leffler was found in a “mismatched” donor-recipient pair at Johns Hopkins. In return for her mother getting a kidney from a living donor, Hargis agreed to donate her kidney to a “mismatched” recipient.