Surgeons at the Johns Hopkins Hospital in Baltimore, Maryland, USA, have performed the first ever simultaneous six-way kidney transplant surgery including six donors and six recipients that were matched using a “domino” system that depends on philanthropic or altruistic donation to facilitate better matching of recipients with free donors.

The whole method said to be the first six way transplant of its kind, was performed last Saturday, 5th April. It took 10 hours, used six surgical theaters and required nine surgical teams, including a total of 100 nurses, doctors and other medical and administration professionals.

In a statement released by the hospital yesterday, all 12 patients are absolutely alright.

The six-way “domino” started when five of the recipients attended the hospital for the estimation of cost, each with a willing donor (a friend or a relative known to the recipient), but in each case, the donor’s tissue and blood type did not match the recipient’s.

It was only when a sixth volunteer donor was found, a so called “altruistic” donor who was prepared to donate a kidney to no particular recipient and whose blood and tissue type matched one of the recipients, then it became possible to swap the pairs around so that each of the five recipients was better paired to get a kidney from one of the donors, who was not necessarily a person they knew (i.e. not the donor they originally came forward with).

The kidney from the donor whose blood and tissue was minimal reconcilable with that of the five recipients was then available to donate to the first patient on the “waiting list” with a good match. Thus six well-matched donor-recipient pairs were formed in a sort of “domino” effect with the last domino being the patient on the waiting list. (The “waiting list” was the United Network for Organ Sharing’s (UNOS) recipient list.)

In this kind of system, the more incompatible pairs that come forward, the greater the chance that better matching can be formed.

All six donor surgeries took place at the same time, after which the kidneys stayed in the same rooms, which were then sterilized before admitting the recipients and giving them their new kidneys.

Johns Hopkins said that each of the donors will now be examined for the rest of his or her life to ensure the kidney they have left remains healthy. And the recipients will be examined weekly for six weeks, afterward monthly, and then gradually shaded off.

According to the hospital, the average life expectancy of live donor’s kidney is about 18 to 20 years.

The transplant team at Johns Hopkins is the pioneers of the system where kidneys are swapped among incompatible donor-recipient pairs. The method is called KPD, abbreviation of kidney paired donation.

The hospital was the first to conduct a KPD triple transplant in 2003, and two years later, in 2005, carried out the first domino triple transplant and a year later, in 2006, the first domino five-way transplant.

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