Triple Kidney swap at San Francisco's CPMC has unique twist

[Marina]

Triple Kidney swap at San Francisco's CPMC has unique twist
http://www.sfexaminer.com/local/2011/11/triple-kidney-swap-san-franciscos-cpmc-has-unique-twist#ixzz1ddfslAKV

Among the living: Most donor kidneys are still harvested from the dead, but kidney donations from people who are still alive are growing increasingly common. (Joseph Schell/Special to The Examiner)

After 12 years of doctor’s appointments and declining health reports, the waiting game was over for Dale Anderson. He needed a new kidney.
His wife, Denise, offered hers, but despite the 14 years the two had spent together, their organs were incompatible.
The fact that Denise’s kidney wasn’t a match was a minor detail — more importantly, she was a viable donor for someone else.
Friday, the Andersons were part of a three-way kidney swap at California Pacific Medical Center set up through a program that matched the couple with two other pairs in the same situation — one in need of a kidney, the other with one who is not a match.

While most donor kidneys are harvested from the dead, donations from the living are becoming increasingly popular and are among the best options for transplant candidates, said Dr. Steve Katznelson, medical director of California Pacific’s Transplant Department. That’s because more people need kidneys and waiting lists are longer for cadaver kidneys than for living donations.
Katznelson attributed the problem to an increase in the number of people with diabetes-related kidney failure and an extension of the age limit for transplants, from people in their 60s and 70s to people in their 80s.
Twenty years ago, wait-listed patients could get a kidney in about six months.
“If you don’t have a living donor option you could wait for years [now],” Katznelson said.
In contrast, within a month, CPMC had matched up, approved for surgery and wheeled into the operating rooms three people who would give their kidneys to strangers so someone they loved could live longer.

But live donations come with a caveat, and it’s a big one: Do you have someone who loves you enough to give up an organ and is also healthy enough to do it?
The three donors in CPMC’s transplant Friday answer that question with a resounding yes.
Live donations come in two forms — swaps, like the CPMC’s program, and chain donations, the more common procedure, in which one donation sets off a series of donations across the country.

Chain surgeries set up through a national registry — the registry includes 200 pairs and CPMC participates in one almost once a month — but with patients spread out across the country, there is also more room for the chain to break.
Comparatively, CPMC’s swap database includes about 80 pairs. Friday’s three-way swap was only the second involving more than four people at the hospital this year. In April, doctors did a five-way swap.
Friday, everything went according to plan. After 2½ hours of surgery Anderson, Ratola and Williams each woke up with one less kidney and one life saved.

Three-way transplant a complex, involved procedure
Nine doctors, six patients, three operating rooms and one goal: save three lives.

At California Pacific Medical Center, the three-way kidney transplant is an uncommon procedure and one that requires careful planning, according to Dr. William Bry, the Surgical Director of the transplant team.
The doctors run through their roles — each surgeon follows one kidney from origin to end.
They color code all their equipment, right down to the coolers that will carry the kidneys.
Over the course of a month they run numerous tests on their patients to make sure everyone is healthy for surgery day.
It’s a complicated process, but it’s worth it, Bry said.
“Up until 10 years ago, if someone had an incompatible donor we just told them they were out of luck and they had to get on the waiting list and wait for a donor to come up,” Bry said.
Bry has been doing kidney transplants since 1986, and the procedure has changed a lot since then.

Donors used to leave his operating room with a 9-inch incision in their lower abdomen and months of recovery ahead.
Now, he can make three, centimeter-long incisions — two for instruments to separate the kidney and one for a camera to show the way — plus one three-inch cut to remove the fist-sized organ.

Six hours later and all six patients will be resting comfortably with a new combination of kidneys.