The accidental kidney donor

(St. Louis) In trying to close the chapter on a long medical ordeal in her life, Toni Brookhouse opened a new chapter in the lives of at least four other people.

Brookhouse, 42, a special education teacher and mother of two from West Frankfort, IL, had surgery at Barnes-Jewish Hospital on Nov. 9, 2009, to remove a damaged ureter (the tube that carries urine from the kidney to the bladder) and the healthy kidney connected to it.

The kidney was packed immediately in ice and flown to Johns-Hopkins Hospital in Baltimore, where it was transplanted into a patient who had been on the waiting list for a kidney. Brookehouse was what is known as an “altruistic donor” – a living person who donates an organ to a recipient they don’t know.

Her altruistic donation kicked off a chain of transplant surgeries in which at least four patients, so far, have received transplants.

The recipient of Brookhouse’s kidney, like the other kidney recipients in the chain, did have a family member willing to donate a kidney to them. But that willing donor was not a match to the recipient. In return for getting Brookhouse’s matching kidney, that donor gave their kidney to another person who had a willing, but non-matching donor, and so on.

This type of kidney swap is called “matched paired donation.” Barnes-Jewish has participated in matched paired donation chains with Hopkins and other institutions several times.

According to doctors at Barnes-Jewish and Hopkins, the chain of transplants kicked off by Brookhouse’s donation could eventually include more patients and go on into January 2010.

“I’m just glad I could help somebody,” Brookhouse said.

The problems began when Brookhouse had abdominal surgery in 2001 at another hospital. During that surgery, her bladder and left ureter (the tube connecting the kidney to the bladder) were damaged. Over the next eight years she had two major reconstructive surgeries to try to fix the damage.
Although the surgery fixed some of the bladder damage, other complications developed, including repeated clogging and infection in the ureter. Fifteen months ago, she began undergoing procedures every two months to place stents in the ureter to keep it open.

“I was sore for three or four days afterwards,” she said.

But even these procedures eventually failed. Doctors told Brookhouse that the problems with her ureter would eventually result in having to have her kidney removed.

Her nephrologist referred her to Martin Jendrisak, MD, Washington University transplant surgeon at Barnes-Jewish Hospital and surgical director of kidney transplant, to see if there were any alternatives.

Dr. Jendrisak told Brookhouse that he could take out her kidney and re-implant it lower in her abdomen, bypassing the damaged ureter. But there were no guarantees that this would solve the problem. The only other option was to simply have the kidney removed.
Brookhouse felt she could no longer endure the physical pain or emotional rollercoaster of failed operations. She told Dr. Jendrisak she would prefer he just remove the kidney.

That’s when a light bulb went off, he said. “If I was going to take out a healthy kidney anyway, why not see if she would want to donate it?”

With more than 80,000 Americans on the list for kidney transplants, he thought, there would surely be a match somewhere for Brookhouse's kidney.
Brookhouse welcomed the idea of having some good come out of her ordeal, although it required some extra testing. In the meantime, a potential recipient for her kidney was found on the waiting list at Hopkins.

As doctors search for ways to cope with the growing number of patients who need organs and the flat level of organ donation, they are finding “alternative” ways to match donors and recipients. Paired kidney exchanges between hospitals have become more common, said Dr. Jendrisak.

“Something like Ms. Brookhouse’s surgery is a win-win situation,” he said. “She was going to lose the kidney eventually, but now someone else was able to get a healthy kidney.”