Canadian docs keen on repeating kidney 'swap' after success
By Amy Minsky, Canwest News ServiceJune 25, 2009 5:12 PM
OTTAWA — Mere hours after making history, Canadian doctors have already set their sights on repeating it.
Eight patients and more than two dozen medical professionals made Canadian medical history Wednesday when they took part in the first cross-country kidney "swap."
Kidney swaps begin with a person who wants to donate a kidney to a loved one, but is incompatible. That donor then agrees to donate a kidney to a stranger — as long as another donor agrees to donate his or her kidney to the original donor's family member.
On Wednesday, after months of planning by the Canadian Blood Services, doctors in Vancouver, Toronto and Edmonton removed kidneys from four living donors and transplanted them into four patients suffering from kidney failure.
And Dr. Peter Nickerson, the executive medical officer for transplantation at CBS, said the next potential exchanges have already been identified.
"Now we're working through the logistics associated with the exchanges," he said about the next swap, which is expected to take place by the fall.
Wednesday's operations took place at St. Paul's Hospital in Vancouver, the University of Alberta Hospital in Edmonton and Toronto General Hospital and began cutting at precisely the same time in three separate time zones across the country.
The operations were co-ordinated this way in order to avoid the chance of one donor backing out after his or her loved one received a healthy kidney.
"There's always the theoretical risk that, at the last moment, one of the donors may decide that they don't want to go through with this," said Dr. Gerry Todd, of Edmonton, who spent two hours retrieving the kidney from one donor before putting the organ into its recipient over another 2 1/2 hours. "But it's more of a theoretical thing, because these donors are very, very committed."
Nickerson said that, for the first inter-provincial "domino" transplant, doctors decided to work with a relatively small pool of patients.
"We felt a maximum of four or five recipients and donors was a good size to start with," he said. "We had to see first and foremost (that) we didn't put anybody at risk as the complexity and the logistics of this was set up."
The hope, Nickerson said, is to eventually set up a bigger swap with more patients. "But we need the manpower to be able to co-ordinate the surgeries and pull it off," he said.
Currently in Canada, about 35,000 people suffer from kidney disease, and 3,000 people are on waiting lists to receive transplants from a deceased organ donor.
The domino surgery, which effectively removed four people from their local wait list for a deceased donor's kidney, was initiated by one altruistic live donor who decided to donate a kidney to a stranger. That stranger's incompatible loved one then agreed to donate a kidney to another recipient whose loved one, in turn, donated a kidney to someone else in need. That person's loved one made the final donation to someone on the kidney waiting list.
Often, potential donors can't give a kidney to a loved one because of incompatible tissues or blood-types.
A new live-donor registry, co-ordinated by CBS, allows for that donor to give to a stranger whose loved one will return the favour to another patient.
Nickerson said the hope is that more pairs — a donor and incompatible family member — will sign up to the registry.
"Altruistic donors make this much easier," Nickerson said. "But it's a fact they are few and far between. So we don't want to be handcuffed to that."
Though this is a first in Canada, surgeons and patients in the U.S. have been taking part in domino kidney transplants for some time. In February, doctors in three U.S. states performed a 12-patient, six-way living donor domino surgery.
With files from Edmonton Journal
http://www.canada.com/Health/Canadian+docs+keen+repeating+kidney+swap+after+success/1732355/story.html
I Hate Dialysis Message Board
Author
