Monday, December 14, 2009

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

“A whole new doorway of hope opened,” said Tom Otten, a suburban St. Louis police officer who traveled halfway across the country to Georgetown University Hospital to give a stranger a kidney so that his wife would get one in return.

Relative after relative failed to be the match his wife, Irene, needed. Tests finally showed her body wouldn’t tolerate a kidney from 95 percent of the population.

In Washington, 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, Mr. Otten turned out to be Mrs. Williams’ needle in the haystack. Another young woman was Mrs. Otten’s. Mrs. Williams’ father came from Florida, the answer for yet another impossible-to-match grandmother.

“It’s a large gift to give somebody, something so selfless,” Mrs. Williams said, her hand clutching Mr. 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.

“You are going to die a lot earlier sitting on that dialysis machine than if you get transplanted,” said Dr. Melancon, whose goal is to pair domino kidney exchanges and the blood-cleansing treatment called plasmapheresis to narrow the troubling disparities.

Of the 88,000 people on the national waiting list for a kidney, just more than 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.

“These procedures really multiply the number of transplants that can be done,” Dr. Melancon said, predicting the two together could enable up to 4,000 additional transplants a year. “It’s really almost a religious experience when we start doing this, because it’s miraculous, it really is.”

The Associated Press documented weeks of the complex logistics, the ups and downs as Dr. Melancon’s team planned initially for a 16-way transplant, juggled donors and recipients for best matches and had to drop some out - including one with heart problems that aborted his surgery.

In the end, 13 pairs emerged with life-altering bonds.

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