Paired Kidney Exchange Helps Patients Obtain Organ Match

St. Louisan Ken Crowder needed a kidney after his kidneys had failed from undiagnosed hypertension. His fiancée, Rebecca Burkes, wanted to give him her own kidney. A dialysis nurse, Burkes knew that Crowder’s best shot to regain health was a living donor kidney transplant. Unfortunately, she was not a match.

Crowder was able to get a kidney from a living donor Dec. 6, 2010, in the first paired kidney exchange (PKE) transplant done as part of a national pilot program run by the United Network for Organ Sharing (UNOS). In a paired kidney exchange, a medically incompatible recipient and donor are matched with another recipient/donor pair in a similar situation. The two pairs swap donor kidneys.

“This transplant is a milestone in the history of transplant,” Surendra Shenoy, MD, says. “It changes the way transplant is done in the United States.”

Crowder’s kidney came from a woman in New Hampshire who had wanted to donate to her sister-in-law, but was not a match. She donated her kidney at Dartmouth-Hitchcock Medical Center in Lebanon, NH, and it was flown to St. Louis. As part of the exchange, Burkes donated her kidney at Barnes-Jewish. It was flown to New Hampshire and transplanted into the sister-in-law of the woman who donated to Crowder.

Dr. Shenoy and Jason Wellen, MD, Washington University transplant surgeons, performed the donor and recipient surgeries at Barnes-Jewish. The UNOS pilot program facilitates PKE transplants between incompatible donor/recipient pairs at 77 transplant centers across the country. A successful pilot could lead to the establishment of a national registry of living donors, which could save the lives of many.

“Since performing the first Barnes-Jewish organized-PKE in a swap involving 16 patients at three medical centers in February 2009, the kidney transplant team at Barnes-Jewish Hospital has become one of the most experienced at PKE in the country,” says Dr. Shenoy, director of living donor transplant at Washington University School of Medicine and Barnes-Jewish Hospital.

Heart and kidney transplanted simultaneously

Jonathan Sadowski, a 20-year-old from O’Fallon, Mo., had a heart transplant shortly after he was born. Two years ago, that heart began to fail, which caused his kidneys to fail, too. In the past, doctors would have told him that his failing kidneys made him ineligible to receive a new heart. But the Washington University transplant physicians at Barnes-Jewish Hospital told him that receiving a new kidney along with a new heart was possible and would extend his life.

Sadowski became the first person to receive a combined heart-kidney transplant at Barnes-Jewish Hospital, in a two-stage, two-day procedure. He was discharged from Barnes-Jewish just 11 days later.

Data have shown that for certain patients, such as Sadowski, transplanting a donor kidney at the same time as the heart results in increased chance of long-term survival, says Gene Ridolfi, Barnes-Jewish Hospital Transplant Center director.

“And only a handful of transplant centers have the depth of specialized resources and personnel available to perform such a complex procedure, and then provide ongoing care,” says Jason Wellen, MD, Washington University transplant surgeon at Barnes-Jewish Hospital.

I-wen Wang, MD, PhD, cardiothoracic surgeon, transplanted the donor heart into Sadowski June 2, 2010 and Dr. Wellen transplanted the donor kidney the next day. Due to the success of Sadowski’s procedure, the Barnes-Jewish Hospital Transplant Center expects to evaluate several patients for combined heart and kidney transplants each year.

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