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Five Precious Gifts
Hopkins makes medical history with a 10-person domino transplant

Some donors and recipients at the press conference, from left, seated, Sheila Thornton, Lonnie Brooks, Sandra Loevner, Leslie Persell, Florence Jantzi, Kristine Jantzi and Honey Rothstein.

It’s noon on Nov. 14, and in hallways around the general operating room, everyone is saying, “The donors are done.” Now five more men and women—the recipients—are being put to sleep.

Until this moment, all had faced prolonged dialysis and certain death from end-stage kidney disease. But over the course of this one fall afternoon, each will receive a gift more precious than anything they could have ever hoped for this holiday season—a working kidney from a living donor.

These patients and their donors are part of what is believed to be the first five-way domino transplant in the world.

A “domino” transplant begins with someone like Honore “Honey” Rothstein. A computer programmer from Martinsburg, W. Va., Rothstein is a “nondirected,” or altruistic, donor. Her first husband, who died suddenly, was an organ donor. Her daughter also died suddenly, but her organs were unsuitable for donation. On behalf of her deceased daughter, Rothstein decided to make an extraordinary sacrifice: She herself would donate a kidney to someone—anyone—in need.

Her largesse kicked off a chain of matches in a pool of four couples who had come to Hopkins for evaluation. Each pair consisted of a recipient and a willing but incompatible donor.

helicopter in flight

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Rothstein, it turned out, was compatible with one of the recipients, Kristine Jantzi, of Bangor, Maine. Florence Jantzi, a Christian missionary from Ontario, Canada, was incompatible with her daughter. She could, however, donate a kidney to Lonnie Brooks, a mechanic from Clermont, Fla. The process would be repeated with two more incompatible pairs, creating a domino effect, with the final available kidney going to the next compatible person on the United Network of Organ Sharing waiting list—retired school teacher Sheila Thornton of Baltimore.

Here in the GOR on Nov. 14, the plan is for each of the five attending transplant surgeons to insert into a recipient the very kidney he removed from a donor in the morning. Each kidney, packed in ice in a sealed cooler, has remained in its respective operating room.

On the whole, things are relatively calm, considering the staggering logistics involved in staging five simultaneous operations in the morning and five more intimately related operations in the afternoon. “In part,” says Comprehensive Transplant Center administrator Brigitte Reeb, “that’s because everyone involved—doctors, nurses, techs and the immunogeneticists who test for matches, about 75 in all—got together last week to go over their assignments.”

And yet, despite the best-laid plans, a few surprises lie in store for the surgeons. Miguel Tan’s recipient needs dialysis during surgery. Keith Melancon’s needs a central line in the event of future dialysis. Warren Maley is bumped from Room 18 to smaller Room 5 because, Reeb explains, “a liver is coming.”

blank helicopter in flight
Dorry Segev, at right, with Mazen Bedri operating on a kidney recipient.

Each OR has a different atmosphere. In Room 1, Dorry Segev is positively buoyant. Across the hall, in Tan’s Room 2, things are more subdued. In Room 4, Bob Montgomery wants his music (Tom Petty, The Doors) turned up loud. Melancon, who favors MIX 106.5, occasionally bursts into song.

Johns Hopkins pioneered kidney donation among two incompatible pairs beginning in 2001. The first three-way paired donation was done here in 2003. In 2005, an altruistic donor was introduced into a pool of three incompatible donor-recipient pairs, creating what is thought to be the world’s first three-way domino transplant.

Domino paired donation can significantly increase the number of transplants. Writing in The Lancet, CTC director and chief transplant surgeon Montgomery and colleagues assert that altruistic donors benefit because even when their transplants fail, there’s at least one more chance for a positive result. Recipients, who typically have hard-to-match blood types, also benefit, as do those on the UNOS registry—people like Sheila Thornton.

To protect their privacy and keep emotions at bay, donors and recipients are anonymous throughout the matching process, which is overseen by transplant coordinator Janet Hiller, known affectionately as the “kidney matchmaker.” But ultimately, most are eager to meet.

The helicopter has all the trappings of a miniature ICU.
Kidney matcher Janet Hiller with donor Sandra Loevner.

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That is what happened on Monday, Nov. 20, when for the first time, donors and recipients came together. At an emotional press conference, Montgomery called for a national paired kidney exchange program so that far more could benefit. This gathering, Montgomery said, “helps us realize how an altruistic spirit like Honey Rothstein’s can benefit not just one person but five and that living transplant donation can—and does—transform lives.”

—Anne Bennett Swingle

 

 

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