26 Operations And 13 Kidneys Later … The Ultimate Gift

Mon, 12/14/2009 - 5:07am

Lauran Neergaard, AP

Doctors in the nation's capital have performed a record-setting kidney swap, part of a pioneering effort to expand transplants to patients who too often never qualify. These 26 operations put healthy kidneys into 13 desperately ill people.

When relative after relative failed to be a match for his wife Irene, Tom Otten, a suburban St. Louis police officer, traveled halfway across the country to Georgetown University Hospital to give a stranger a kidney so his wife would get one in return. Tests showed that Irene’s body wouldn't tolerate a kidney from 95 percent of the population.

Roxanne Boyd Williams was a similar long shot. A sister's kidney had saved her in 2005, but it failed this year. This time around, the 30-year-old mother's immune system also had become abnormally primed to attack any new organ. Dr. Keith Melancon, Georgetown's kidney transplant director, offered a rare option. If both women could receive a close-to-perfect donor kidney — one that few of their immune system's elevated antibodies recognize — he'd filter from their blood enough of the remaining antibodies to allow the new organ to survive.

A kidney exchange widens the pool of potential organs. That's when patients find a friend or relative who isn't compatible with them but will donate on their behalf, and the pairs are mixed and matched.

Like falling dominoes, Tom turned out to be Roxanne's needle in the haystack. Another young woman was Irene's. Roxanne's father came from Florida, the answer for yet another impossible-to-match grandmother.

“It's a large gift to give somebody, something so selfless,” Williams says, her hand clutching Otten's as the two meet a week after surgery. “God bless you.”

The chain reaction — multiplied by three altruistic donors, people offering a kidney to anyone — turned into a 13-way transplant during six marathon days of surgery at Georgetown and nearby Washington Hospital Center. It's believed to be the largest exchange of its kind in a movement that could reduce the nation's long and growing wait for a donated kidney.

Five patients got kidneys only because of the blood-filtering.

And strikingly, 10 of the 13 kidney recipients are black, Asian or Hispanic — important because minorities are far less likely than white Americans to get a kidney transplant from a living donor, the best kind. Of the 88,000 people on the national waiting list for a kidney, just over one-third are black, yet they receive only about 13 percent of living-donor kidneys. Blacks are disproportionately struck by the kidney-killing twin ravages of diabetes and hypertension, leaving those on dialysis with fewer donor candidates among their own family and friends.

For everybody, fewer than 17,000 kidney transplants are performed a year.

The matchmaking that brought Williams and the Ottens to this point is like piecing together a jigsaw puzzle. Every Wednesday afternoon for months, Melancon pulls his transplant coordinators and lab scientists into a top-secret meeting in a cramped conference room. A magnet board holds the names and vital statistics of potential donors, posted on green cards, and recipients, on red ones. Participants can't know who matches whom until the surgery is done.

Numerous transplant centers have done smaller kidney exchanges, and the United Network for Organ Sharing, which oversees organ transplants, is about to pilot-test a system to match donor-recipient pairs from around the country. The goal is to create a large enough national pool to identify a compatible donor for most people, says the group's president, Dr. James Wynn.

A nervous Otten latter peeks into Williams' hospital room, unsure what to say. “I think you have something of mine,” he jokes as Williams reaches out for a teary hug. It's been a roller-coaster week. Williams had some postsurgery pneumonia, but is exhilarated at how fast her new kidney is working — and laughs with Otten that finally, she won't have to wait in the car during bathroom breaks on family trips. He tells of his wife Irene's successful transplant, and how anxious they are to learn about her donor.

Williams shows Otten photos of her children taped onto the ICU wall. “Oh, we're going to play,” she says. “I couldn't keep up with them before. Now I can.”


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