Doctors do three-way organ swap

A three-way kidney transplant exchange has been carried out in New Zealand for the first time.

The process involved taking three incompatible donor and recipient pairings and matching them with each other to allow a transplant to take place.

The transplants took place in Canterbury and Auckland earlier this month and involved some careful planning.

Auckland renal physician Dr Ian Dittmer said while the three-way exchange was ‘‘exciting’’ it was also logistically challenging.

The operations to extract the three kidneys began between 8 and 9am, with the organs on planes by midday. Once the kidneys arrived at their destinations, they were transplanted into the patients and the operations were finished about 7pm. The transplants were carried out by five surgeons, with about a hundred staff across the two locations.

The Christchurch-based National Renal Transplant Service clinical director, Dr Nick Cross, said they became aware of the possibility of the three-way exchange a couple of months ago and had been working on setting it up since.

Cross said kidney exchange was particularly demanding for the public health system because it relied on close collaboration between DHBs. It often meant rescheduling to align multiple surgical and medical teams.

In the case of this exchange, two out of three of the kidneys had to be transported by plane. Medical professionals travelled with the organs on commercial flights.

Cross said kidney transplants were the best and most cost-effective treatment for people with kidney failure, so a successful transplant was a win-win for the public health sector. This particular exchange only cost ‘‘a few thousand more’’ than any other live kidney transplant due to the transport costs.

Health Minister Jonathan Coleman said Kiwis were often keen to help a friend or loved one needing a kidney, but were unable to because of tissue compatibility issues.

The exchange, set up about four years ago, is a database of pairs who are not compatible with each other but still want to donate or receive a kidney. There are about 20 pairs on the New Zealand exchange at any one time. Each time a new pair is added to the exchange, they are checked for compatibility against others on the database.

Kiwi teams carried out two or three two-way exchanges a year.

‘‘Organ transplantation is a lifesaving treatment and for people with organ failure it’s often the only option available,’’ Coleman said.

Dittmer said the first successful threeway exchange opened doors for Kiwis on the kidney exchange list. Often people on the exchange had been waiting for transplants for a long time, he said.

Hopefully, the success of the threeway exchange would help grow the number of people on the exchange list and lead to further exchanges involving three or more donors.

New Zealand was also working with Australia to set up a trans-Tasman exchange, which could result in up to seven transplant pairs being involved in a single exchange.

Dittmer said a lot of good work was being done to increase New Zealand’s organ transplant rate and things were slowly but steadily improving.

A few years ago Auckland was carrying out about 60 transplants a year. This year they hoped to hit 100, he said.

The National Renal Transplant Leadership Team launched two years ago as a collaboration across DHBs includes doctors, surgeons, transplant co-ordinators and administrators.

The Ministry of Health is backing the team in order to increase transplant opportunities for New Zealanders.

The number of kidney transplants (live and deceased) has risen from 118 in 2011 to 147 last year.

Kidney Health New Zealand national education manager Carmel Gregan-Ford said the success of the three-way exchange was fantastic but more donors were needed.

‘‘It’s good to know there are people out there who are still alive and their quality of life has improved,’’ she said.

Gregan-Ford said about 500 people were on the waiting list in New Zealand, compared to about 120 donors.

Cross said becoming a live kidney donor was an ‘‘exceptionally selfless act’’.

‘‘It involves substantial sacrifice of time, a moderate sized operation with associated pain and recovery time, and a small but definite risk of a bad outcome for the donor. Live kidney donors are heroic individuals, and are deserving of our admiration.’’

A new law was passed last month to ensure live organ donors are paid 100 per cent of their normal income during recovery.

Kidney transplants are provided in three DHBs: Auckland, Capital & Coast, and Canterbury.