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Israel’s first successful kidney transplants from cardiac-death donor will expand supply of organs
By JUDY SIEGEL-ITZKOVICH
08/25/2014
For two hours, the kidneys in the 30-year-old man who suddenly died of cardiac arrest were kept cold while they were tested for tissue and blood types, diseases and functioning.
 
Two people in their 50s are alive a month after a successful kidney transplant made possible by organ transplants after cardiac death for the first time in Israel.

The transplants took place a month ago, one on a 57-year-old woman at Petah Tikva’s Rabin Medical Center-Beilinson Campus and the other on a 58-yearold man at Ichilov Tel Aviv Sourasky Medical Center.

The kidneys of a 30-year-old man who died suddenly of cardiac arrest were kept cold for two hours and tested for tissue and blood types, diseases and functioning while his family gave permission for the donation, recipients were prepared and the transplant team was assembled.

Prof. Jonathan Cohen, a South African immigrant who brought the technology from Europe, told The Jerusalem Post on Monday about the approval and adoption of the technology, especially for kidneys but also for livers and lungs.

“It’s not a new technology, in fact that’s the way organ transplantation began and was successful in the 1960s,” said Cohen, who is an intensive care specialist at Beilinson and medical adviser to the National Transplant Center.

But survival rates were low, he explained, because the oxygen supply to the organs halted when the heartbeat stopped. As a result, in recent years organs have been taken from people who went into lower-brain death but whose hearts kept beating.

Brain-death organ transplantation is not accepted by some, including ultra-Orthodox Jews, at least in Israel. Modern Orthodox Jews and Muslims generally accept the onset of braindeath as determining the time of death.

Many potential donors’ hearts stop and die, making it impossible to retrieve the organs. Various tissues, however, such as corneas, skin, bones, ligaments and heart valves, are still transplanted after cardiac death because the oxygen supply is not so critical.

“Eight or nine years ago, improved technology for keeping organs alive was developed in Holland, followed by Spain and Belgium, and later in the US and the UK. The results for kidneys after cardiac death are now as high as those taken from brain-dead donors. Liver transplants after cardiac death involve more complications, but transplants of lungs from people whose hearts stopped beating have started to become more promising,” Cohen said.

The technology involves the cooling down of the organs after the donor’s heart stops beating.

“Cannulae [tubes] are put into an artery and a vein in the groin, and then a cold perfusion solution is run into abdomen. This cools the body very quickly, preserving kidney function,” said the Beilinson doctor. “It is known that if people got lost in snow in Russia, for example, the extreme temperature virtually stops the heartbeat and breathing, but the person can be warmed and revived to function normally. The organs were preserved in time.”

In these first-ever Israeli kidney transplants after cardiac death, the kidneys were kept cold in the body until it was possible to do the transplants.

“It could be done for up to three hours, as long as the temperature remained low,” Cohen said. The organs were then retrieved and attached to a special pump.

This allows perfusion of the kidneys in a special solution and on ice, and they can be kept that way for up to 24 hours.

Cohen introduced the program into Israel, and as head of a committee, wrote the protocols for it after studying it in Holland and Belgium four years ago.

The program was approved after a mock trial of judges and lawyers was held in Tel Aviv a few years ago. The consensus of those hearing the arguments in favor and against was that such a process was legal, ethical, saved lives and didn’t negate the wishes of the donors, he recalled.

The procedure then received the approval of the Health Ministry and the National Transplant Center, headed by Rambam Medical Center director-general Prof. Rafael Beyar.

The successful transplants are “an important step in promoting transplants in Israel. It is important that the public know the solution to the shortage of kidneys is in our hands. Everyone is welcome in accordance with ethics and religion to sign an ADI donor card and express his agreement to donate organs after his death,” Beyar said.

The Health Ministry purchased equipment in the last few months to make the procedure possible. As many potential donors die suddenly and their organs cannot be used, the technique will make it possible to use their organs.
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