- The Washington Times - Monday, April 16, 2007

Young K. Hwang of Oakton and Clinton Johnson of Laurel have swapped wives — but only for their kidneys. In February, the two men underwent life-saving kidney transplants in which their wives, Sun Hae Hwang and Pat Divinnie, each donated a kidney to the other’s husband.

“It’s the grace of God, whether somebody is religious or not,” says 64-year-old Mr. Hwang. “My kidney is a gift from God through a person.”

Almost 96,000 people are waiting for an organ transplant in the United States, more than 70,000 of them needing a kidney, according to the United Network for Organ Sharing in Richmond, a nonprofit organization that manages the nation’s transplant system by contract with the federal government. In 2006, 80 persons in the United States received a kidney transplant through a paired exchange.

Although “donor swap” is the loose term for the procedure the couples underwent, the technical term is a “living paired kidney exchange,” says Josephine Flores, a clinical transplant nurse coordinator at Washington Hospital Center in Northwest.

Ms. Flores and her colleague Leslie Duka Semanyk, also a clinical transplant nurse coordinator, matched the two couples for the procedure.

“One of our jobs is to educate the recipient and the potential living donors to get through the transplant and let them know the risks of surgery,” Ms. Flores says. “We are the quarterbacks. We try to direct them to where they are supposed to be going, such as what kind of tests each and every recipient and donor will have to take.”

Allaying the apprehensions of the donors and recipients is another job of the transplant nurse coordinators, she says.

“Receiving a kidney transplant might be the closest thing to a miracle that a patient with kidney failure will receive,” Ms. Flores says.

When chronic kidney disease progresses, it may lead to kidney failure, which requires dialysis or a kidney transplant to maintain life, according to the National Kidney Foundation in New York City. About 20 million Americans, or one in nine adults in the United States, have chronic kidney disease, and 20 million more are at increased risk, according to the foundation.

High-risk groups for chronic kidney disease and kidney failure include people with diabetes, hypertension and a family history of kidney disease, says Dr. Jimmy Light, chief of transplantation services at Washington Hospital Center in Northwest. He was the team leader for the four surgeries in the hospital’s recent kidney swap.

“Many donors get a lot of reward in seeing the person get better,” Dr. Light says. “This time it’s an indirect reward. If you’re incompatible with your loved one, you might be compatible with someone else in an exchange.”

One of the biggest obstacles with the kidney swap was the logistics of organizing four operating rooms at once, Dr. Light says.

A team of about 30 people arranged and coordinated four simultaneous operations. Two sets of side-by-side operating rooms, one for the donor and one for the recipient, each had a medical team of six persons, including a transplant surgeon, an anesthesiologist, a transplant coordinator, two nurses and a technician. The procedures lasted more than four hours.

“The surgery had a little more tension to try to be sure it went perfectly,” Dr. Light says. “Here you’d feel badly if one patient did well and the other did poorly.”

To be a donor, the donor and the recipient must match their blood types and other immune factors, Dr. Light says. One-third of possible living donors are incompatible with their intended recipients. When trying to find a compatible living donor, swapping organs between pairs of two, three and four people is an option.

Desensitizing a patient and removing incompatibility factors is another option, he says. Patients can go through a process called plasmapheresis that removes harmful antibodies from the blood before and after the kidney transplant. That process, however, is more complicated than a paired exchange. A third option is waiting for a deceased donor.

“The thing that works best with the least fuss is doing an exchange,” Dr. Light says. “Immunologically, it works the best as well. Today’s immunosuppressants work well, and fewer than 10 percent see rejection. Over 90 percent of the transplants should be successful.”

After one year, the organ should retain 95 percent of function, Dr. Light says. After 10 years, it should retain 70 to 80 percent of function.

Although Mr. Hwang still isn’t 100 percent recovered, he says he feels free of worry. In 2002, he was diagnosed with diabetes. In 2003, his doctor recommended that he go on a waiting list for a new kidney. He says he loves his wife so much for her contribution to his health.

“Naturally, whatever we can share, it should be shared for the rest of life,” says 63-year-old Mrs. Hwang. In 1973, the couple moved from Korea to the United States. “It is a very good feeling. My husband got his life back. When I see the other couple, and they are happy. too, I know that we did a really good thing.”

Mr. Johnson, 58, suffers from sarcoidosis, a disease that causes inflammation of the lymph nodes and other organs. He did not want to be put on dialysis and instead held out for a kidney transplant.

Although Mr. Johnson had four friends who volunteered to donate, three were not matches, and the fourth had high blood pressure, which can cause renal disease.

“I was B positive, and [Mrs. Hwang] was B positive. She was born on the 15th of February, and I was born on the 16th of February,” Mr. Johnson says. “I thought it was amazing because there are people that have been on the list for so long.”

Since the surgery, Mr. Johnson has had fluid removed from around his new kidney. However, the organ is working properly, he says.

“So far there has been no rejection,” Mr. Johnson says. “We are both OK. Pat is back at the gym and doing her everyday thing.”

Ms. Divinnie, 55, says there was no question in her mind whether she would give a kidney so that her husband could get one. Although she has never had a child, she says donating a kidney so that someone else could live must be a similar feeling.

“I was certainly willing to do whatever I could so he could receive health,” Ms. Divinnie says. “It went from a hopeless situation to great expectations for the future.”

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