Fortunately, not all hope is lost nor is a lengthy stay on a waiting list required. A multi-patient organ swap, known as a paired donor exchange, can now save the lives of numerous people while matching each patient with the very best kidney for his or her blood profile.
If it sounds a little like a game of connect-the-dots, it is – but on a much larger stage and with much more at stake for the participants and their families. And with nearly 85,000 Americans currently on a waiting list for a donated kidney – nearly 3,000 in Georgia alone – the opportunity to quickly identify and match more organ donors and recipients is critical to saving more lives.
The Emory Transplant Center at Emory University Hospital in Atlanta has recently opened its innovative Paired Donor Kidney Exchange Program, providing greater hope for patients in need of kidney transplants. According to Kenneth Newell, MD, director of Emory’s living donor program, a paired exchange donation is a process that essentially allows healthy individuals to donate a kidney to either a friend, loved one, or even altruistically to a stranger, despite incompatible blood matches. In paired donation, a donor and recipient are matched with another incompatible donor and recipient pair and the kidneys are exchanged between the pairs.
The procedure is another form of living donor transplantation, which means the donated organ may come from a living person such as a friend, spouse or family member. Donated kidneys also come from recently deceased donors. While most kidneys from deceased donors function well, studies have shown that a kidney from a living donor, either a blood relative or an unrelated person, provides the greatest chance for long-term success.
“In essence, paired donor exchanges allow us to cast a much wider net to find compatible donors and recipients,” says Newell. “With a paired kidney transplant, one incompatible donor-pair is able to give a healthy kidney to a compatible recipient. In exchange, the second donor-recipient pair will give a compatible kidney to the first donor-recipient pair, making two compatible living donor transplants possible and increasing the potential number of available donor kidneys. This option can help those patients waiting for kidney transplants who have family members or friends willing to be donors and who are medically suitable, but who have an ABO blood type that is incompatible with the recipient’s blood type.”
Dr. Newell and his team this past month completed the third paired donor exchange surgeries involving a total of six patients – three donors and three recipients – from Texas, Colorado and Georgia. As part of this, as well as one of the two previous exchanges, Emory partnered with the Texas Transplant Institute in San Antonio, the largest independent paired donor program in the country. The program is led by Adam Bingaman, MD, a former Emory trainee who completed both his residency in general surgery and his PhD work at Emory School of Medicine. “To get the ball rolling initially on our program here at Emory, one of the first things we did was partner with the Alliance for Paired Donation,” says Dr. Newell. “APD maintains a database of patients who have incompatible donors from over 50 other transplant centers, and the Alliance runs a computer program once a month to find matches between them.
“After about a year, we decided to focus on developing our own database rather than depending on APD’s, and we naturally approached Dr. Bingaman about collaborating,” says Newell. “Now, building our own listing of donor-recipient pairs remains paramount, an effort expedited by weekly meetings and consultations. Whenever new candidates are added, the data is shared with Dr. Bingaman’s program, further increasing each patient’s chance of receiving a compatible kidney from a living donor.”
Howard Scott and Casey Campbell
Howard Scott describes how he came to receive a new kidney. Duration: 5:10 min.
Casey Campbell describes her donation experience. Duration: 4:10 min.
Howard Scott’s journey toward receiving a kidney transplant began more than 10 years ago when he befriended Casey Campbell. Scott, now living in Macon, Ga., and Campbell, now a resident of Denver, became part of the large exchange network when Campbell learned of her longtime friend’s need.
“I received a new kidney this month, but my story actually started 10 years ago when Casey was in college and we worked on a couple of plays together. Over the years we stayed in touch,” recalls Scott. “In December, 2008 I suffered a heart attack and soon after had a quadruple bypass, suffering renal failure shortly after and beginning dialysis.”
Scott chose to be a part of the transplant program and signed up to be listed. He was told the wait could be as long as five years. “I was an adopted child and had no family to go to for a matching organ, but I was told about live organ donation. Many friends offered kidneys, but unfortunately none were the matching Type O. I was certainly prepared to remain on the waiting list for the long term.” One night, however, while chatting online with his friend Casey, she, too, offered to donate one of her kidneys. After being screened, it was again determined that her blood type was not a match.
“Casey would simply not accept that answer,” says Scott. “She went online and learned about the paired exchange donor program, and we both soon signed up as donor and recipient. Within three weeks we were ready to go. We had a chain of kidneys, and I was one of three recipients. Although I don’t have Casey’s kidney (hers actually went to another recipient in Texas) I have someone else’s kidney today because of her.”
“I had seen a great deal of media recently about kidney transplants, and as soon as I had a friend who needed one, that changed everything and I said ‘let’s go,'” Campbell recalls.
“I knew almost right away that I would not be a blood match, but I had heard about the paired donor exchange and knew about the program. When I learned that Emory had one in Georgia, it made perfect sense. There wasn’t ever any pressure to do this from anyone. I never got scared because it always felt like the right thing to do.”
While her good friend Howard never received his life-saving gift directly from Campbell, she says she feels part of something much bigger.
“I feel like I’ve done something massive,” says Campbell. “This donation will not change my life or the way I live. I can live my life the same way as always, but now someone else, and in this case many more people, can live normal lives, too.”
The Robert W. Woodruff Health Sciences Center of Emory University is an academic health science and service center focused on missions of teaching, research, health care and public service. Its components include the Emory University School of Medicine, Nell Hodgson Woodruff School of Nursing, and Rollins School of Public Health; Yerkes National Primate Research Center; Winship Cancer Institute of Emory University; and Emory Healthcare, the largest, most comprehensive health system in Georgia. Emory Healthcare includes: The Emory Clinic, Emory-Children’s Center, Emory University Hospital, Emory University Hospital Midtown, Wesley Woods Center, and Emory University Orthopaedics & Spine Hospital. The Woodruff Health Sciences Center has a $2.5 billion budget, 17,600 employees, 2,500 full-time and 1,500 affiliated faculty, 4,700 students and trainees, and a $5.7 billion economic impact on metro Atlanta.