Israel’s first “domino triple kidney-pair exchange” was performed at the Rabin Medical Center-Beilinson Campus in Petah Tikva last week, providing organs to three people whose would-be donors did not have a compatible blood type.

Until now, a handful of Israeli double kidney-pairs have been swapped this way to increase the donor pool, but a few quadruple domino swaps of kidneys have already been performed in the US.

The medical center and Israel Transplant, an organization that deals with organ transplants, on Tuesday announced the Israeli advance, which requires of the hospital’s transplantation center a supremely high level of coordination and skill removing three kidneys from three live donors and transplanting them into three others simultaneously. About a third of patients who have a willing living kidney donor are not able to receive the donor kidney because of an incompatible blood type. In the past, that would mean that patients would have to wait for years on dialysis until a deceased donor kidney became available.

In the new swap, Bob Reinham from England decided to give a kidney to Inbar Magen; Inbar’s mother Malka gave a kidney to Rita Farhi; and Rita’s husband Nissim gave a kidney to Natan Hanegbi. Nissim had wanted to give his kidney to his wife Rita, who has been undergoing painful and time-consuming kidney dialysis, but he did not have a compatible type.

Nine surgeons, five anesthesiologists, dozens of operating theater and recovery nurses, blood bank workers and other professionals were needed to make the effort successful. It began when Natan Hanegbi, a 59-year-old man from Tekuma who had type B blood, needed an urgent kidney transplant. At the same time, 26-year-old UK native Bob Reinham decided he wanted to give one of his kidneys to an Israeli he did not know. Bob has type O blood and can thus donate to anyone.

Inbar Magen, a 20-year-old woman from Petah Tikva with type O blood, suffered from kidney failure. Her 54-year-old mother Malka wanted to donate a kidney to her, but she has type A. Rita Farhi, 55, of Kfar Saba, needed a kidney after hers failed and she had to undergo dialysis. Her 58-yearold husband Nissim was not suited, as he has type B blood.

The pairs met for the first time at Beilinson a few days before the operations for comprehensive tests. It was emotional not only for the donors and recipients but also for the hospital staffers involved.

Prof. Eitan Mor, who heads the transplant department, said that domino kidney exchanges have been performed in the US, Australia, Holland and Taiwan, with data banks to coordinate details of would-be donors and recipients to facilitate swaps. Now Israel, through Beilinson, has begun to build such a data bank, with Dr. Ruth Rahamimov and Rahel Michovitz in charge of it. Israel Transplant hopes that in the future, this country will be able to join an international bone marrow data bank for such exchanges.

The kidneys were removed by Dr. Andre Nadu and Dr. Dani Keidar of Belinson’s urology department and Dr. Yoram Dekel of Carmel Medical Center in Haifa. They were transplanted by Mor, Dr. Ezra Shaharabani, Dr. Sigal Eisner, Dr. Evyatar Nesher and Dr. Michael Gurevitz of Beilinson and Dr. Ran Steinberg of Schneider Children’s Medical Center.

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