Chain kidney transplants: triple donation between Padua, Barcelona and Bilbao
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Three cities involved in an international chain of living kidney donations and transplants, an initiative never done before. On 20 June, the National Transplant Center for Italy and the Organizacion nacional de trasplantes for Spain coordinated in the space of 18 hours the execution of three blood samples and three transplants in the hospitals of Padua, Barcelona and Bilbao, crossing three immunologically incompatible pairs of donors and recipients. This is the fourth “cross over” exchange of kidneys between Italy and Spain (the first was carried out in August 2018) but in all previous cases only two couples had been involved at a time, one for each country.
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The chain of interventions
The chain of interventions started from Italy. At 8.30 on 20 June, at the Padua university hospital, the professor Lucretia Furian started the first kidney collection from a 56-year-old voluntary donor, wife of a 61-year-old patient with very difficult transplantability, hyperimmunized and in need of a new kidney for the third time. At the end of the operation, the organ was immediately transported to the Milan-Linate airport with the coordination of the Veneto Regional Transplant Center directed by Dr. Giuseppe Feltrin and with the support of the Traffic Police and the 118 service of the Paduan company.
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From Padua to Barcelona and Bilbao
The kidney took off at 1pm on a dedicated medical flight and arrived at Barcelona airport at 2.30pm. The first exchange was carried out in the Catalan airport: the organ of the Italian donor was taken over by the health workers of the Hospital Clinic to carry out the first transplant, while a second kidney was brought on board the aircraft, taken around 12 from a Spanish donor. The plane left for Bilbao, where the next exchange took place at 4.30 pm: the kidney of the donor in Barcelona was taken to the Hospital Universitario de Cruces for the second transplant and a third kidney, taken from the Basque hospital, was embarked with destination Milan. The air transport ended at 18.30 in Linate, from where the last organ was immediately transported to Padua by the traffic police: at 20.30 the third transplant began on the Italian patient, performed by professor Paul Rigottidirector of the local Kidney and Pancreas Transplant Center.
A marathon of over 2,000 kilometres
The intervention ended after 2 in the morning, at the end of a 2,713 km long marathon. “Two weeks after the surgical operations – the doctors explain -, recipients and donors are in excellent condition and the transplants can be considered successful”.
The triple cross donation was made thanks to the South Alliance for Transplant (Sat), an international agreement involving Italy, Spain, France and Portugal to identify common cooperation programs with the aim of giving greater possibilities of receiving an organ especially to patients who are difficult to transplant.
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Synchronized work
About the difficulty of the procedure speaks Massimo CardilloDirector of the National Transplant Center. He says: “An international chain of this type requires an enormous commitment first of clinical evaluation and then of organizational planning, to perfectly synchronize the work of all the teams and hundreds of operators, and successfully complete the interventions in the shortest time possible to the benefit of a type of patient who otherwise would have very little chance of finding a compatible organ”.
“It is therefore an exceptional event – continues Cardillo -, but it is part of the wider effort we are putting in place to promote living kidney donation, which in the vast majority of cases can take place directly between related couples. In Italy we still do too few (in 2022 there were 335, just over 16% of the total number of kidney transplants) and we still have over 6,000 people on the waiting list”. For Cardillo it is essential to reassure patients and family members: “Living donation is a widely tested procedure, it involves very low risks for the donor, while transplants of this type achieve very positive results on average. Encouraging this activity is one of the best ways we have to be able to give an opportunity to thousands of people forced to wait a long time on dialysis”.
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