A nephrology and surgical team from the SJD Barcelona Children's Hospital and Hospital Clínic Barcelona have successfully performed a transplant of two kidneys from the same donor into two identical twin paediatric patients. It is the first transplant of its kind performed in Spain, according to the data from the National Transplant Organisation of Spain (ONT).
The boys were born with a autosomal polycystic kidney disease, a hereditary disorder that causes cysts to develop within the kidneys, causing a slow and progressive loss of kidney function, which makes a transplant necessary in the long-term.
The medical team of the Nephrology Unit at the SJD Barcelona Children's Hospital who attended them, led by Álvaro Madrid and Marta Jiménez, posed the option of a kidney transplant to the patients' family this March because, at 11 years of age, their kidneys were only functioning at a level of 10%.
An ethical dilemma: how to intervene in twins with the same pathology
At first, the team considered the option of implanting a kidney from a living donor from the children's family environment. "Since the parents are of the same blood group, the initial idea was that one of the parents could donate a kidney to one of the children and the other parent, to the other. But when carrying out the donor study, we saw that the mother was a possible donor, but not the father, and the rest of the relatives were incompatible. This situation presented us with an enormous ethical dilemma; we could not do a transplant in only one of the two children when they were in an identical clinical situation. There was no objective criterion that pointed to one requiring a transplant more urgently than the other,” says the head of the SJD Nephrology Service, Álvaro Madrid.
Once the living donor option was ruled out, the medical team then decided upon a deceased donor and registered the two boys on the waiting list of the Catalan Transplant Organisation (OCATT). Thanks to the generosity of a family and the organisation of the entire operation by the coordination offices of the ONT and the OCATT, the transplant could be performed simultaneously on the two children shortly after.
In a few hours, the two boys went into surgery – first one, and after that transplant was finished, the other – to receive their new kidney. The surgeon Mireia Musquera from the Hospital Clínic de Barcelona, who forms part of its Urology Unit directed by Antonio Alcaraz, participated in the surgical intervention. Also involved from the Clínic were Antoni Vilaseca and Mònica Peradejordi.
The brothers remained in the hospital together at all times. They overcame certain complications and progressed favourably. Currently they only require outpatient monitoring.