May 1, 2018

Breaking the 'taboo': Is it safe to transplant the same kidney twice?

Daily Briefing

    Last July, surgeons at Ronald Reagan UCLA Medical Center performed an unusual procedure: a second transplantation of a previously donated organ—a "taboo" move that shows how far some doctors and patients will go to find transplantable kidneys amid a nationwide organ shortage, Sarah Zhang writes for The Atlantic.

    Here are 5 key tactics to attract and retain transplant patients

    Why are re-transplantations so rare?

    Every day, 13 people die waiting for a kidney in the United States, Zhang writes. The U.S. kidney transplant list has 100,000 people on it, of whom only 17,000 are likely to get the transplants they need each year, according to Zhang. 

    In light of the organ shortage, doctors have tried numerous tactics to expand the donor pool, including accepting organs from older donors. But few have been willing to re-transplant previously donated: "It’s almost like taboo to re-transplant a kidney," according to Jeffrey Veale, the surgeon who performed the re-transplantation in July.

    Experts caution that such procedures are not without risks.

    Richard Formica, a nephrologist at Yale University and the secretary of the American Society of Transplantation, said, "These kidneys have gone through multiple rounds of insults," including the death of the original donor, cold storage, reperfusion injury during the initial transplant, and immune system-suppressing drugs that can damage kidneys—all of which are repeated when transplanted for a second time. "Few kidneys would be good enough," he said.

    Another challenge is the lack of data supporting the re-use of transplanted organs. A handful of case studies have been published on the topic, but "[c]ase studies are not clinical trials," Zhang writes.

    Alejandro Lugo, who published a follow-up case study on a reused kidney transplant, said creating a clinical trial would be difficult because reusing transplanted organs is "too infrequent and too difficult to structure a trial."

    As a result, Veale estimates that similar procedures have been performed only about 30 to 40 times in the United States between 1988 and 2014—three of which Veale performed himself.

    Details on the surgery

    The kidney used in this case had been transplanted two years previously from a 17-year-old girl into a man in his early 20s. When the man later died in a car accident, surgeons determined that the kidney was still viable: The original donor had been young and healthy, and the second donor had creatinine levels—a measure of kidney function—that were acceptable.

    That's when Veale reached out to Vertis Boyce, a 69-year-old woman from Las Vegas, asking if she wanted the kidney. Boyce had been on the donor list for about nine years, and at age 69, she wasn't sure when she'd get another chance—so she said yes.

    Veale extracted the kidney himself. During the procedure, he discovered that scar tissue had formed after the initial transplant, a potential obstacle to re-transplantation. To ensure he would could implant the kidney into Boyce's body, Veale removed some of the second donor's iliac blood vessels, which supply blood to the legs, and transplanted both in Boyce—meaning she now has tissue from two donors in her body.

    Boyce said the transplant has changed her life. She no longer needs dialysis three times a week and has been able to travel. "I felt free," she said (Zhang, The Atlantic, 4/12).

    Here are 5 key tactics to attract and retain transplant patients

    Download this briefing to learn how to expand the pipeline of potential transplant patients and engage them across the care pathway.

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