[First renal transplant chain involving an altruistic donor performed in Spain].

In recent years, we have witnessed a progressive decrease in the number of cadaveric donors. 1 This fact, together with the rapid development of laparoscopic surgery in Urology, has enhanced the living donor in kidney transplantation programs now accounting for 12% of all transplants performed in Spain. 2 Overall, the grafts from living donors have an average life longer than the cadaveric ones; however, up to 30% of the potential pairs have ABO (system of classifying blood groups by a or b antibody) incompatibility or positive cross match, which substantially decreases the potential beneficiaries. In these cases, the alternative is a long waiting list for cadaveric donors, or desensitization protocols with plasmapheresis/immunoabsorption and intravenous immunoglobulins. 3 Both alternatives have shown an overall graft survival lower than those from negative cross match pairs. Transplant chain from altruistic donor Altruistic donor receptor on waiting list for deceased donor Figure 1 Renal transplant chain involving an altruistic donor. ଝ Please cite this article as: Breda A, et al. Primera cadena de trasplantes a partir de un donante altruista realizada en España. In this scenario, the possibility of getting a kidney from a negative cross match living donor from a transplant chain program initiated by an altruistic donor, also called 'Good Samaritan', represents a very attractive option for these patients. The first chain of transplants was performed in the U.S. in 2006, 4 and it currently has wide acceptance in countries such as Korea and Holland. 5,6 In order to achieve compatibility between the patients, the National Kidney Registry (www. kidneyregistry.org) has the necessary software available to get up to a trillion chance of crossing starting from a small number of pairs entered into the program. Although the chain principles consider the performance of donations and transplantations non-simultaneously to create a large number of transplants, our chain began and ended on the same day to avoid the risk that any member reconsidered the donation and abandoned it. Thus, jointly between the Fundació Puigvert (FP) and the Hospital Virgen de las Nieves (HVN), the first chain of transplants performed in Spain was carried out on April 6, 2011. The procedure began at 9 AM with the living donor nephrectomies performed simultaneously with the altruistic donor and the other two donors. The kidney from the altruistic donor was transplanted into 'B' immediately after the extraction in the PF. The kidney of 'A' was sent to HVN …