Here's a video in which Mike Rees, the founder of the Alliance for Paired Kidney Donation (APKD) describes how (with the help of a grant from Stanford Impact Labs) the APKD is helping Brazilian transplant docs get kidney exchange going there.
Earlier:
Stanford Impact Labs (SIL) reports on our recent kidney exchange conference
Global Solutions-focused Summit on Expanding Access to Kidney Transplantation held at Stanford. Physicians, scholars, healthcare practitioners, and policymakers gathered to explore research advances underway in India, Brazil, and the U.S. by Kate Green Tripp and Marina Kaneko
"Earlier this month, the Alliance for Paired Kidney Donation (APKD), Stanford economist Alvin E. Roth, and Stanford Impact Labs hosted the Palo Alto Summit, a two-day global convening at Stanford University dedicated to exploring challenges and advances in kidney transplantation around the world.
"On the heels of the 2025 World Transplant Congress in San Francisco, more than 30 physicians, scholars, transplant coordinators, and government officials from the U.S., India, Brazil, Italy, the United Arab Emirates, Qatar, and South Africa gathered to share key learnings, challenges, and advances in the field.
...
" APKD and Roth, the Craig and Susan McCaw Professor of Economics at Stanford’s School of Humanities and Sciences, have teamed up with transplant specialists in India, Brazil, and the United States to form the Extending Kidney Exchange project.
...
"The summit’s sessions were designed to advance national efforts in KPD in India and Brazil, and deceased donor-initiated chains (DDIC); foster collaboration among leading clinical, policy, and academic partners; and identify actionable steps and shared milestones for KPD in India and Brazil, paired liver exchange in India, and DDIC in the United States. As a transplant strategy, DDIC utilizes kidneys from deceased donors to create a chain of transplants so as to maximize the use of available organs and to connect multiple recipients, especially when there are mismatches or compatibility issues.
...
"“When the very first [nonsimultaneous] chain of kidney transplants took place in 2006, it was not necessarily welcomed as an innovation,” recalls Michael Rees, a transplant surgeon at the University of Toledo and founder of the Alliance for Paired Kidney Donation (APKD). “It is incredibly exciting to reflect on the progress we’ve been able to make across the transplant community since that time, to increase the utility of a single kidney from either a living or deceased donor.”
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Earlier:
In August I posted about a trip to Brazil with Mike Rees where we traveled with Dr. Gustavo Ferreira, the director of transplantation at the hospital Santa Casa de Misericórdia de Juiz de Fora
Part of our trip was spent in the capital, Brasilia, talking to the government about extending Brazilian transplant law to allow kidney exchange, after which we went to Juiz de Fora. Here's my blog post about that trip: Kidney exchange in Brazil: prelude.
That post concluded by saying "On Saturday we had an exciting finish to the trip, but it's not my story to tell yet, so I'll blog again after there is an official announcement."
Now Brazil's first three-way kidney exchange has been announced, as part of a clinical trial that I hope will help change Brazilian law to allow kidney exchange as a regular medical procedure. The three donors and three recipients all did well, and left the hospital very shortly after the actual surgeries, but came back to tell their stories to the Brazilian news show Profissão Repórter (Professional Reporter). You can see the video here https://globoplay.globo.com/v/12997336/
It's in Portuguese but you will quickly get the idea, presented even more briefly on Instagram by the transplant nephrologist Dr. Juliana Bastos here: https://www.instagram.com/reel/DA4JBVIsFta/?igsh=d2hnb3hoNjJxN2I4 where you can see the three incompatible patient-donor pairs rearrange themselves for the camera into the three-way exchange in which each patient received an organ from a compatible donor. (Dr. Bastos recently added a PhD to her MD, with a dissertation on kidney exchange.)
Here's another Instagram link to the video.
I had the privilege of observing parts of five of the six surgeries (three nephrectomies and three transplants), and some pictures are below.
If someone directs a movie about this kind of transplant surgery, there will be two dramatic scenes, one in which the donated kidney is carried across the hall to the transplant operating room, and the second showing the moment the clamps are removed from the blood vessels of the transplanted kidney, so that it turns from grey to pink as blood returns to it.
But here's a photo I took at the start of what I think is the most dramatic moment of the surgery, as the artery from the kidney is just about to be connected to the artery of the recipient.
The artery from the donated kidney is the small white tube being pointed to by the instrument held in the fingers at the top right of the picture. Immediately in front of it--the long red tube--is the artery of the recipient, to which it must be connected so that blood can again flow to the kidney. Notice that a small incision has already been made in the recipient's artery--this is where the two will be attached. The connection has to be perfect, so that the blood can flow without obstruction that could cause a clot.
I was able to follow the proceedings thanks to the running commentary offered to me by the Brazilian surgeons and by Mike Rees (who wasn't busy doing surgery). That wasn't the only kind of support Mike offered me in the OR (as I balanced on a pair of stools to better appreciate the commentary):
And here's a post-op picture of most of the big team that made it happen:
Yesterday I flew home from a busy visit to Brazil, with Mike Rees and Dr. Gustavo Ferreira.
On Wednesday we all traveled to the capital, Brasilia, meeting with government ministries and agencies about how to move kidney exchange forward there.
Our most promising meeting on Wednesday was with the company that organizes the hospitals associated with Brazil's Federal universities. We talked about research possibilities
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| Wednesday Aug 7: Brazilian Hospital Services Company |
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| Thursday: Brazil Ministry of Health, August 8 2024 |
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