First Successful Post-cardiac Death Kidney Transplant Performed in Israel

Expected to substantially increase the number of kidneys available for transplant among those who do not accept brain death as definitive.

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Doctors at Kaplan Hospital in Rehovot are fighting to save the life of a seven-month-old suffering from a rare case of botulinum toxin poisoning. (Illustrative photo)
A patient in surgery (illustration.)Credit: Getty Images

For the first time in Israel, doctors have successfuly transplanted the kidneys of a donor after cardiac death, Israel’s National Transplant Center announced yesterday.

Health officials hope that the methodology used for the transplant will substantially increase the number of kidneys available for transplant in the country, 

Most organs for transplant are currently retrieved after the donor has been certified as brain dead but before the heart stops beating — the state known as cardiac death.

Partly because many religious authorities do not accept brain death as definitive, the number of Israelis registered as organ donors is relatively low, as is the number of families willing to allow organs to be harvested for transplant from a family member after brain death only.

But waiting for the donor’s cardiac death reduces the transplant success rate; when the heart stops, the organs lose their oxygen supply.

The new methodology is already used in several countries, including Holland, Spain and England. Officials hope its use here will make up to 30 percent more kidneys available for transplant, reducing by up to a year the time transplant candidates must wait for an organ.

Over the past two years, four local medical teams have been trained in the new method. It was finally employed a month ago, when a man of about 30 was brought to Rambam Medical Center in Haifa after suffering cardiac arrest. After resuscitation attempts failed, the hospital obtained the family’s consent to donate his kidneys using the new procedure.

“We’re talking about a complex logistical arrangement,” said Prof. Rafi Beyar, the chairman of the National Transplant Center’s steering committee and the director of Rambam. “New equipment was used, including an automatic resuscitation device that continues to massage the heart and keeps the blood flowing to the kidneys even after the heart has stopped working. In addition, a special solution is inserted into the body that helps preserve the kidneys.”

After the kidneys were removed, they were taken to two different hospitals: At Tel Aviv’s Ichilov Hospital, one kidney was transplanted into a 58-year-old man, while at Petah Tikva’s Beilinson Hospital a 57-year-old woman received the other kidney.

Beyar says just four hours elapsed between the pronouncement of the donor’s cardiac death and the start of the transplant operations. “Aside from the new equipment, it was very important that the medical teams were trained and prepared,” Beyar said.

For now, this is still considered an experimental procedure.

“The transplant surgery we did was routine, but the kidney we received had been through some trauma during the process,” said Dr. Roni Baruch, who heads the transplant clinic at Ichilov. “The question in this case is how long it takes the kidney to recover. In the case of our transplant recipient, three weeks after the surgery he was still on dialysis and no urine was being produced. But over the last week there has been urine production, the kidney’s function is improving and dialysis has been stopped.”

According to the National Transplant Center, some 1,000 Israelis are waiting for an organ transplant, with some 700 of them waiting for kidneys.

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