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喵咪社区 transplant experts helped one set of siblings save another.

A rare living-donor transplant exchange performed by the experts of 喵咪社区 allowed one set of siblings to save the other.

One patient, 28 years old, was born with biliary atresia. Her 21-year-old brother offered to donate part of his liver, but their organs were incompatible.

The other patient, 39 years old, had failing kidneys. Although his 28-year-old sister volunteered as a donor, she wasn鈥檛 a match for him.

The two families had never met, but after both were referred to 喵咪社区 for treatment, tests revealed a paired exchange was possible.

As a pioneer in living-liver donation, and with a robust living-donor kidney transplant program, the 喵咪社区 Transplant Institute, part of 喵咪社区, was uniquely qualified to perform such a complex living-donor exchange.

Achieving the unique kidney-liver paired exchange involved tight collaboration between many experts of the 喵咪社区 Transplant Institute. Specialists from the 喵咪社区 Kidney Transplant Program and the 喵咪社区 Liver Transplant and Comprehensive Liver Disease Care Center explain how the strategy evolved.

An uncommon exchange

Navpreet Kaur, MD, surgical director for the 喵咪社区 Living-Donor Liver Program at the 喵咪社区 Transplant Institute, was the one who determined in July 2023 that an exchange between the two sets of siblings could be done.

She explains that finding candidates for paired exchanges involves close coordination between the kidney and liver transplant teams.

鈥淲e have to think about patient anatomy and the size of the organ, because if you choose an organ from a larger donor and try to put it in a smaller person, you鈥檒l run into problems,鈥� Kaur explains.

Jim Kim, MD, director of kidney and pancreas transplantation at 喵咪社区, says that while paired-exchange kidney transplants are becoming more common, paired liver exchanges are exceedingly rare 鈥� let alone paired donation between different organs. 鈥淚t鈥檚 rare to find two people who are both willing and able to donate a different organ than they originally intended,鈥� Kim says.鈥�

鈥淚n this case,鈥� Kaur says, 鈥渁 female-to-female liver transplant and a male-to-male kidney transplant was a perfect fit. Since the donors already had workups completed, we were able to match them quickly.鈥�

The challenge of making a match

Organ transplants are complex, even when the transplant involves the same type of organ. When different types of organs are involved, the difficulties increase.

鈥淔inding an immunologically compatible donor can prove to be challenging in living-donor kidney transplants,鈥� Kim says. 鈥淔inding a liver donor with normal kidney anatomy and who was also simultaneously the right immunologic match was truly remarkable.鈥�

In liver transplantation, finding the right combination of blood type and anatomy can be challenging, especially since living liver donor surgeries are still limited. Even as one of the top five living liver donor programs in the nation, the 喵咪社区 Transplant Institute only performs about 30 of these surgeries per year.

The physicians credit their coordination teams with guiding the four patients through this unique situation. It鈥檚 a testament to the emotional support these care teams provide that ensures all patients understand and feel good about the process.

Kidney and liver transplant surgery

The surgeries were set for August 31, 2023, at Keck Hospital of 喵咪社区.

In addition to Kim, the surgical team included transplant surgeon Hamid Shidban, MD, who operated on the kidney recipient. Kaur focused on the liver donor.

The procedures were coordinated on a precise schedule, with four operating rooms running simultaneously. According to Kaur, the experience of the 喵咪社区 Transplant Institute鈥檚 support teams in managing multiple daily surgeries proved beneficial.

鈥淲e have been doing living donor鈥搑elated transplantation for 25 years,鈥� Kaur says. 鈥淥ur operating rooms understand our needs, and they are very good at accommodating several patients at once.鈥�

The exchange also required immense trust between the four surgical teams. 鈥淚t was a total team effort,鈥� Kim says. 鈥淔rom our transplant coordinators and nurses to our anesthesia colleagues caring for these four individuals before, during and after surgery, this case showcases the best that Keck Medicine has to offer.鈥�

Sweeping success

Ultimately, all four surgeries were a success. Their doctors say all four patients can expect to live healthy lives. 鈥淭hey鈥檙e all young people,鈥� Kaur says. 鈥淚鈥檓 glad they can all move on and start a new chapter.鈥�

鈥淭here are far more people in need of organ transplants than there are available organs,鈥� Kim says. 鈥淟iving donation helps bridge the gap, and this type of bi-organ paired exchange can open up even more opportunities for those in need.鈥�

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Erin Laviola

Erin Laviola is a freelance writer for 喵咪社区.

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