10 Kidney Transplants in 2 Days: Coordination Matters

Even the highest-volume kidney transplant centers average fewer than two transplants a day, so conducting 10 in just 2 days is an extreme rarity. But that’s what happened at Vanderbilt University Medical Center in Nashville, Tennessee, during a stressful — but successful — Labor Day weekend.

Vanderbilt’s transplant teams were called in on that Saturday and Sunday to perform five procedures each day after 10 kidneys from deceased donors were matched with patients.

“It felt like a steady stream and flow throughout the weekend, where we kept receiving organ offers and coordinated across our teams to make it happen,” said Rachel Forbes, MD, associate professor of surgery and chief of kidney and pancreas transplantation.

For just a single transplant, a multidisciplinary team of about 150 people typically works from pretransplant to posttransplant in a carefully coordinated dance to ensure the procedure goes well. During the 10-transplant weekend, nephrologists, surgeons, anesthesiologists, intensivists, nurses, nurse practitioners, pharmacists, social workers, nutritionists, organ procurement coordinators, preservationists, perfusionists, operating room staff, janitors, and other critical staff members collaborated throughout the entire holiday weekend to ensure that 10 people received new kidneys and were recovering on the transplant floor by Monday.

Team members on call decided to work to their maximum available hours, and those not on call chose to come in anyway, Forbes said. The teams worked across shifts, taking breaks as required and filling in for others to make it happen.

“There was excitement in the air, especially because it’s a time-sensitive moment when organs can’t be out of the body for too long. It feels like now or never,” she said. “It helps knowing that everyone on the team is willing to go the extra mile, which boosts the excitement for this life-changing and lifesaving moment.”

A Rare Event

Vanderbilt, which conducts an average of 265 deceased-donor and 46 living-donor kidney transplants for adults per year, is the ninth-busiest center in the country, according to the latest data from the Scientific Registry of Transplant Recipients. The Mayo Clinic Hospital in Phoenix, Arizona, tops the list with 381 deceased-donor transplants and 121 living-donor transplants.

Typically, Vanderbilt performs an average of one or two kidney transplants per day, with some days without transplants and an extremely rare day where five may be performed in 24 hours, she said. In this case, that rarity happened two days in a row.

Vanderbilt’s 10-transplant weekend “was unusual and rare,” said Joseph Vassalotti, MD, chief medical officer of the National Kidney Foundation. “It shows the effort that’s required at times to maximize kidney transplant procedures.”

Although living-donor kidney transplants can be scheduled to meet the needs of the donor, recipient, and transplant center, deceased-donor kidney transplants occur sporadically and may present scheduling and staffing challenges, said Vassalotti, who is also clinical professor of medicine at the Icahn School of Medicine at Mount Sinai in New York. Mount Sinai Medical Center performs about 200 deceased donor kidney transplants and 65 living donor kidney transplants in a year.

“Rising to the challenge is an important way to maximize the use of available kidneys, especially with more than 97,000 Americans on the deceased-donor kidney transplant waitlist,” Vassalotti said.

Creating a Transplant Culture

Vanderbilt was able to rise to the occasion thanks to its transplant teams’ embrace of a quality-improvement culture. Since the fourth quarter of 2023, they’ve embarked on initiatives focused on maximizing the number of organs that can be used and making sure patients are ready when they receive a call.

“As we say, ‘Every kidney counts,’” Forbes said. “We find ways to use the ones that are offered.”

The careful coordination and teamwork spirit on display that weekend was fostered by quality initiatives centered on supporting transplant teams so they can do their jobs well, Forbes said. Surgical teams, for instance, created call schedules with “primary,” “backup,” and “weekend” leaders so everyone can be prepared for a potential wave of transplant offers and trust that they have support if needed.

“If we turn down organs because we’re tired or don’t have the resources or bandwidth, then people are waiting longer for lifesaving treatment,” she said. “This new system has allowed for more comfort among our surgeons and nephrologists as we try to stretch the limits on what’s possible.”

Attention to the mission of offering organ transplants to as many patients who would benefit as possible isn’t limited to the transplant teams.

“Everybody is committed to that, and it’s a culture within the center from the top down, where some of the people in administration have been involved with transplantation, and it’s personal to them,” said Joseph Magliocca, MD, professor of surgery and director of the Vanderbilt Transplant Center.

Each month, Magliocca and the different organ system teams review transplant outcomes, discuss trends, and develop quality improvement initiatives. Leaders and team members alike emphasize open, nonjudgmental discussions when discussing improvements, especially after complicated surgeries or in morbidity and mortality meetings, he said.

“Chance favors the prepared mind, and performing 10 kidney transplants across two days doesn’t happen just by chance,” Magliocca said. “We’ve worked for the past decade to grow our transplantation program, become a regional referral center, and offer the best outcomes we can to as many patients as possible.”

A Record-Breaking Year

Vanderbilt serves as Tennessee’s only full-service transplant center and one of the most experienced in the Southeast. It’s handled more than 13,000 solid-organ transplants since 1962.

Breaking a new record in fiscal year 2024, the medical center’s transplant teams performed 809 transplants overall, which earned Vanderbilt a United Network for Organ Sharing ranking as the fifth-largest transplant center in the country. That figure is up from 665 transplants in fiscal year 2023 and 645 transplants in fiscal year 2022.

Fiscal year 2024 was a record-breaker specifically for adult heart, lung, liver, and kidney transplants, with 333 kidney transplants and four kidney/pancreas transplants.

Looking ahead, the Vanderbilt Transplant Center is aiming even higher, with a goal of becoming one of the largest transplant centers in the United States and reporting top outcomes. For that to happen, transplant teams intend to accept more organs, prepare their patients, and continue a supportive shift schedule that supports them in turn.

“Doing transplants at that scale — and doing it well — requires many years of building systems that work and recruiting people who feel the commitment,” Magliocca said. “When it’s important to the institution, the patients, and the transplant teams, and it’s clear why we’re doing what we’re doing, that’s what makes this a great place to work.”

Carolyn Crist is a health and medical journalist who reports on the latest studies for Medscape, MDedge, and WebMD.