The Johns Hopkins University and Hospital physician explained the importance of each musician knowing his or her own part, especially going into the type of kidney transplants Montgomery is so well-known for – those involving 5, 10, even 12 people at one time for a paired kidney “swap” or “domino” surgery.

“Initially, I act as the conductor, but then at some point I have to release that, go in and do a transplant and play an instrument myself,” said Dr. Montgomery, who plays a variety of different roles at Johns Hopkins, including Associate Professor of Surgery, Director of the Incompatible Kidney Transplant Program, Chief of the Division of Transplantation and Director of the Comprehensive Transplant Center.

Even when he’s performing his own part in one of his headline-grabbing kidney swaps, Dr. Montgomery is always attuned to how the other surgeries are going. And, when all the transplants are complete – as was the case this past Valentine’s Day when he led a successful 12-person kidney swap – Montgomery personally visits each patient and then ends the day alone in his office.

 “It then hits me – the magnitude of what we’ve done,” he said.

For Dr. Montgomery, who began his career at Johns Hopkins 22 years ago, the success of paired kidney transplants and other innovative transplant procedures he’s pioneered (laparoscopic donor nephrectomy, positive crossmatch and ABO incompatible transplantation to name a few) are among his greatest accomplishments.

“I probably, in my entire career, will end up doing close to 2,000 transplants,” Dr. Montgomery said. “That’s what I can do with my own hands, but if you can create an innovation that results in 100,000 people being transplanted … the impact of that is so great.”

Still, it’s the patients who are the No. 1 priority for Dr. Montgomery – and why his mind is constantly swimming with new ideas, new opportunities to help more and more receive the kidney transplants they need.

 “What are the problems? Why can’t we do this better? I think about this all the time,” he said.

Dr. Montgomery’s interest in kidney transplantation began more than two decades ago, when, as a student, he cared for his kidney transplant patient.

“The thing that appealed to me about transplantation was that, first of all, the impact that it has on the life of the patient and their family in that it is truly a life-transforming procedure,” he said. “I also really was very interested in being a surgeon but also following patients longitudinally. One of the great privileges of my career is I’ve been able to get involved in the lives of the patients I’ve transplanted and the opportunity to have meaningful relationships with them and care for them. Those are the things that I love about what I do. It gives me great meaning to be a part of this most important time in their lives.”

Although Dr. Montgomery performs liver and pancreas transplants as well, most of his time now is spent with patients who have barriers to kidney transplantation. Examples are those who have become sensitized to other people’s tissue or blood, making it difficult to find a match, or they’re just technically tough to transplant.

“I’ve become more and more of a one-trick pony,” he said.

Dr. Montgomery has also been working on new procedures to use the body’s own natural openings to allow for live kidney donation. Most recently, he removed a kidney through a woman’s vagina. The patient only needed a minimal incision and was able to go home the next day.

“I think that’s going to be a new frontier,” Dr. Montgomery said of natural opening kidney removals.

Regardless of the method, Dr. Montgomery’s end goal is always the same: remove obstacles for live kidney donation and help develop a national program for paired kidney transplants and other new procedures.

“It’s pretty clear that live donation is going to be a major part of bridging the gap between the need for organs and the supply for organs,” he said.

“I think one of the great challenges in the next few years is to take what we’re doing here nationally, hopefully work with UNOS (United Network for Organ Sharing) and get these people transplanted. My efforts are going to be mostly focused on taking the innovations we pioneer here everywhere.”

At the same time, Montgomery sees encouraging possibilities for stem cell and bone marrow therapy benefitting kidney transplant patients.

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