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Surgeons at the California Pacific Medical Center (CPMC) in San Francisco have gotten pretty good at doing kidney transplants; they have done about 200 of them per year since 1968. But over the next two days, a team of five surgeons and over 60 support staff will complete a six-way kidney transplant, operating on 12 individuals: 6 donors and 6 recipients.

Most people are born with two kidneys, which filter out the body’s wastes and regulate blood pressure. If the kidneys start failing, a person may need a donated kidney; if a patient is lucky, a friend or relative will agree to be the donor, giving up one of his well-functioning kidneys. If the donor is healthy and has a blood type that is compatible with the patient, he can undergo the four-hour surgery during which surgeons remove one kidney and put it immediately into the recipient. Transplants from a living donor can extend a patient’s life by 15-20 years, sometimes longer.

If a compatible donor isn’t available, the patient is placed on a waiting list for a matching kidney, and the wait time could put her life at risk. But sometimes, a donor makes a deal with the hospital: he agrees to give up his kidney to a stranger, and in exchange, his relative receives a kidney from a different volunteer donor. Using specialized software, the hospital treating the patient can look for matches for both recipient and donor.

Matching up donors and patients rarely works out quite so neatly. The person who started off the CPMC transplant chain was an “altruistic donor”—someone who agreed to give up a kidney without a specific donor in mind. “The altruistic donor creates this whole cascading effect of possibilities in matching people,” says Dean Fryer, the media relations manager at CPMC. Using the patient-donor matching software, the head of the transplant department came up with a chain of six transplants—a particularly long chain for just one hospital. “It very seldom goes to that number of people because it’s hard to match up that many people, but they were all patients of CPMC, so we were able to match them,” Fryer says.

Here’s how a six-way transplant chain works.

To prepare for the two-day surgical marathon, the director of the kidney transplant program orchestrated the schedule and staff. Nurses and other support staff will check and re-check the charts to make sure each patient is in a stable condition, and to make sure that the right person is getting the right kidney. With the logistics so well mapped out, says the hospital, the 12 patients aren’t at any higher risk than they would be in a shorter transplant chain.

As more people in the US require kidney transplants, hospitals may see longer transplant chains like this one, Fryer says. To him and many others at CPMC, overcoming the logistical challenge is worthwhile to give six more people a second chance at life.

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