Aug 27, 2015 — The wait list for organ donation has reached an astounding number, and it only continues to grow. But doctors have discovered a new way to transplant kidneys that were never considered usable before. The kidneys of very young children who died prematurely were thought to be too small to transplant to adults, but a new procedure called en bloc transplantation has been found to be very effective. In this podcast, Dr. Jeffery Campsen answers questions about an en bloc procedure.

Interview

Interviewer: Expanding the kidney donor pool with en bloc kidney transplantation. What is it? You'll find out next on The Scope.

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Interviewer: We're with Dr. Jeffery Campsen, he is a surgical director of kidney transplantation. We're going to talk about something called en bloc kidney transplantation. Is that how you pronounce it? En bloc or is it en bloc?

Dr. Campsen: Either way is fine, potato, potato. It's EN and then bloc. Some people call it lollipop kidneys. Basically what we're talking about is transplanting two kidneys from the same donor at the same time. In the United States, there are thousands of people on the waitlist for kidney transplants and there are not enough organs available. Dialysis keeps people alive, but ultimately they want a kidney transplant.

Interviewer: Nothing replaces a kidney.

Dr. Campsen: Nothing replaces a human filtering kidney. So many medical centers, high-volume transplant centers have started trying to expand the donor pool by using organs that we used to not. And one of the areas is an extremely young donor. Unfortunately, young children die and often their organs are not used because they're deemed too small to be used.

Interviewer: And how young are we talking?

Dr. Campsen: For this discussion we're going to talk about children that are less than a year old.

Interviewer: Okay.

Dr. Campsen: Really less than 15 kilograms or less than 10 kilograms. Very, very small children. And as you can imagine, just one of their kidneys is not enough to filter an adult who a normal adult's greater than 70 kilograms so it's a significant size mismatch.

But what we found is if we keep the kidneys together, meaning that they're en bloc, they're not separated at the time of donation and transplant them together into an adult that actually ends up being enough kidney volume to filter an adult. But then what we found that's really cool about this is that these kidneys grow, and over time over the next year, the kidneys will grow to almost adult size.

So at this point, a person who has kidney failure that gets the small kidneys will ultimately almost get two kidney transplants so they come off of dialysis and they do very well. And these are organs that were being wasted or discarded, not thought to be able to be used in the past.

Interviewer: Yeah, so normally a child can transplant to another child, but if you don't have another child then now they can be used in adults as well.

Dr. Campsen: That's exactly right. So what we talk about with transplantation is you have to have a blood supply and then you have to be able to produce urine for kidneys. And so the arteries and veins are the blood supply. And in the past, surgically, we thought that maybe these arteries and veins are a little small and are high risk to transplant.

But because we keep them together and use the great vessels to sew them in the aorta and vena cava, the vessels aren't as small. And then, what we can do is they stay open. They don't clot and the organs are successful. They are higher risk in the sense that they do have the predisposition to want to clot. So we use anticoagulation in these kidneys.

So the medicine and the surgery behind it is more complicated than a complicated transplant in the first place, but at a center that does these like the University Utah, and has done them successfully, our patients can benefit from these types of donors. We have a good relationship with Primary Children's Hospital and other children's hospitals in the country, which then allows us access to these organs so they're not wasted.

Interviewer: So I think where we are going with this message now at this point is that conversation that we all should have as adults, now we need to include our children as well if something was to happen, realizing that organ donation is a possibility and you could bring some good to a real bad situation.

Dr. Campsen: That's the perfect way of putting it. Unfortunately, people are going to die. And unfortunately, children are going to die. And what transplantation offers is something good coming out of that tragedy.

Interviewer: Is this something that parents that know that they have a child that might be high risk for other reasons that might die soon after birth, would those kidneys be able to be used, or are those still a little too young?

Dr. Campsen: That's a great question too. There are surgeons in the United States now experimenting with those very, very small kidneys. Talking about patients that are just being born or just after birth, that is something I think we're moving towards and those transplants that have been done have worked. And it's a high level of difficulty. You have to have it done at a center that does these and specializes in these types of en bloc pediatric donors. And that's what we're starting to provide here.

Interviewer: A very exciting time for you and for anybody that would need organs, especially in a time of shortage. Any final thoughts?

Dr. Campsen: I think when you come to your transplant center, you basically talk to them about your options. And if your transplant center offers you some unique ways of getting transplanted, whether it's very small donors, these en bloc kidneys or it's a live donor chain or anything else that that they offer you, keep an open mind because ultimately getting our patients off of dialysis is the goal. And it's complicated because there are just too many sick people and not enough organs.

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