23 doctors, 10 hours, 6 ORs, 5 lives: The logistics of an innovative kidney exchange

Johns Hopkins surgeons completed the nation's first five-way kidney swap. Here's how they linked living donors with unrelated recipients.

By Damon Adams, AMNews staff. Jan. 1/8, 2007.

Hours after making history at Johns Hopkins Hospital, surgeon Robert Montgomery, MD, PhD, retreated to the solitude of his office. He sat mostly in darkness at 10 p.m. and stared at a poster diagram of the organ donors and recipients operated on that day.

There was no champagne celebration. Just quiet reflection, and the realization that he and his colleagues had accomplished the first five-way kidney transplant.

"The day had been kind of surreal. Then later I thought, 'Wow, look what we did,' " said Dr. Montgomery, who headed the transplant team. "It was one of those great moments in one's life, and I just felt so privileged to be part of it."

In one day, Dr. Montgomery and his fellow transplant surgeons simultaneously removed five kidneys from living donors, then placed the organs in five recipients. Start to finish, the quintuple transplant took 10 hours and required six operating rooms.

Johns Hopkins had done triple swaps before, but it broke new medical ground with the five-way exchange. Boldly going there took great skill, precision, cooperation and coordination. The massive undertaking required the planning and work of nearly 100 medical professionals, including critical care doctors, nephrologists, operating room nurses, technicians and pharmacists.

"It's like an orchestra. You have a conductor and you have all the instruments, and each instrument knows what it's supposed to be doing," Dr. Montgomery said. "You keep it straight by having people responsible for different pieces of it, and they understand their piece very well."