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Innovative Techniques in Kidney Transplant

Mix and Match

What happens when your friend wants to donate a kidney to you, but you are not a match; or different hospitals have patients who need kidneys without matches? The answer is a highly successful coordination and swapping of kidneys that delivers compatible kidneys to the people who need them. Key to a kidney swap success is starting with someone willing to donate a kidney, be it to a family member, friend or complete stranger.

The Domino Swap

Valentine’s Day this year was a very good day for six kidney recipients. Love was all around, and all it took was a game of dominos. That day, a surgical team at Johns Hopkins Hospital in Baltimore started a cross-country set of surgeries, beginning with one altruistic donor and ending with a recipient on the United Network for Organ Sharing (UNOS) organ registry.

Called a kidney paired donation (KPD), a group of incompatible donor-recipient pairs get matched with other pairs with the same problem. In this case, there were three surgical teams involved at Barnes-Jewish Hospital, Johns Hopkins Hospital, and Integris Medical Center in Oklahoma City.

Like falling dominos, Hopkins flew one kidney to Integris Baptist, which flew one kidney to Barnes-Jewish, which flew a kidney to Hopkins. SurendraShenoy, MD, PhD, and Martin Jendrisak, MD, kidney transplant surgeons at Washington University and Barnes-Jewish Hospital, took part in the domino swap, and they hope it will set a national model for more living donor transplants to get more people off the long kidney transplant waiting list. Chief transplant surgeon at Hopkins, Robert Montgomery, MD, PhD, estimates that this national match and kidney transport model will result in as many as 1,500 additional transplants each year.

First Matched Paired Kidney Transplant

Giving the Gift of Life

For the first time in October 2008, the number of people in this country registered and awaiting an organ transplant exceeded 100,000.

More than 83,000 Americans are waiting for donor kidneys, but only 15,000 transplants occurred last year due to the shortage of donors.

Barnes-Jewish is the largest kidney transplant center in the region, doing about 150 each year, half of which are from live donors.

Anyone can be an organ or tissue donor, depending on physical condition. You can mark it on your driver’s license or carry an organ donor card. Most importantly, discuss your decision with family members and loved ones, who may have to carry out your wishes.

Ten days after the successful domino swap, on Feb. 24, 2009, surgeons at Barnes-Jewish performed the institution’s first matched paired kidney transplant. Two patients received kidney from donors they had not known. The transplants were done with simultaneous surgeries in four Barnes-Jewish operating rooms by Jendrisak and Shenoy, along with Jeffrey Lowell, MD, and Niraj Desai, MD.

Joel Swisher wanted to donate a kidney to his best friend Richard Pauli, who had kidney failure from polycystic kidney disease, but he wasn’t a match for Pauli. He was a match, however, for Danny Pracht, whose kidneys failed from an infection. Another altruistic donor, Dane Clark, was willing to donate a kidney to a stranger and was a match for Pauli. Clark donated his kidney to Pauli, and Swisher donated his to Pracht. All four operations were successful and the kidneys were functioning well.

Without those living donors, Pauli and Pracht would have had to wait for kidneys from deceased donors an average of three to five years.

Although not a Valentine’s Day gift, the new kidney paved the way for Danny Pracht’s romantic future.

He was healed in time for his wedding to his sweetheart Sarah on June 6. “Sarah was very excited about the transplant and that I would be healed by the wedding,” he says. “I had been on the transplant list for a year and was going to have to start dialysis. I was trying to hold off on that until after the honeymoon but I was getting really tired.” He flew his donor, Swisher, to Union, Mo., from Detroit for the ceremony, and the two keep in touch by phone and e-mail. Theirs is a special bond.

Super Domino Swap

More good news. The Valentine’s Day domino swap had given great hope to Shenoy for a national precedent to get more kidneys to people who need them.

Those hopes were further realized June 22 with the start of a 16-patient kidney transplant that involved four medical centers across the country: Integris Baptist in Oklahoma City, Johns Hopkins in Baltimore, Henry Ford Medical Center in Detroit and Barnes-Jewish Hospital. The series of paired kidney exchanges that began that day ended July 6, with eight patients having received kidneys from eight live donors over three different days.

The super swap started at Barnes-Jewish Hospital with Mu Cha Leffler receiving a kidney from a donor at Johns Hopkins. Her daughter Christine Hargis had intended to donate a kidney to her mother to end her two-year dialysis regimen, but she was not a match. On the ending day of the swap, Hargis, in return for her mother having received a kidney from a live donor, donated her kidney to another mismatched recipient, also at Johns Hopkins. The domino swap model continues to build momentum and bring new hope to patients with kidney failure.

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