Doubling up on kidney donations

Doubling up on kidney donations

A new transplant matching system
has increased patients' chances
twofold.

By JOSEPHINE MARCOTTY, Star Tribune

Last update: January 8, 2010 - 10:14 PM

At 6:45 a.m. Thursday, the surgeon in
Maryland called Eugenia Steffens with an
anxious question: How's the weather out
there in Minnesota?

Don't worry, said Steffens, a transplant
coordinator at Hennepin County Medical
Center: The airport won't close.

With four surgeries and two lives in the
balance, it's no wonder the two of them were
watching the forecast.

At 1 p.m., a Northwest Airlines flight took off
from the Twin Cities with precious cargo:
Kathie Blomstrand's kidney, destined for a
transplant patient in Baltimore. Meanwhile, a
flight was leaving Baltimore for Minneapolis
carrying a kidney that would be transplanted
Thursday night into Blomstrand's husband,
Floyd Johnson.

The two-way kidney swap between HCMC
and the University of Maryland Medical
Center this week was a dramatic example of
the next best idea in transplant medicine: A
highly choreographed computer exchange
that matches living donors with people in
kidney failure across the country. It
promises to save millions of dollars in
medical costs and end the ordeal facing many
of the 80,000 kidney patients on the nation's
transplant list, who face a wait of five years
or more to get an organ from a deceased
donor.

"If this paired exchange hadn't taken place, I
don't think I would ever have gotten a
kidney," a grateful Johnson, 73, said before
he went into surgery on Thursday. "I'm too
old."

Nor would the transplant patient in Maryland
have gotten a kidney, said Dr. Matt Cooper,
director of kidney transplantation at the
Maryland medical center. Very few people in
the general population would have been a
match for his patient, he said.

Only a large, computerized data base of
potential donors could find her that "needle
in a haystack," he said.

That rare donor turned out to be Blomstrand,
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a 60-year-old registered nurse from Duluth.
By sending her kidney to the patient in
Maryland, she gave her husband the gift of a
kidney sent back in exchange. She jumped at
the chance to help her husband get off
dialysis and return to the life of hunting and
fishing that he loves.

"He was able to do less and less of that," she
said. "I really wanted him to get a kidney."

These sophisticated national organ
exchanges are still in their infancy, and
Minnesota hospitals are only now beginning
to participate. In November the Mayo Clinic
did a four-way swap among three kidney
patients at the Rochester clinic and one at its
Arizona clinic. In the last two years,
transplant centers in other states have done
several hundred such paired exchanges. Late
last year, the organization that manages the
national transplant system for the federal
government launched a pilot program that
could eventually create a nationwide
matching system.

Growing waiting list

With the rapid spread of kidney disease in
the past two decades and an ever-longer
waiting list for organs from deceased donors,
"the wait times are becoming unpalatable,"

said Dr. Mark Odland, Johnson's transplant
surgeon at HCMC. "You have to start looking
for alternatives."

Minnesota, which has four transplant
centers, could quickly become a national
leader in such exchanges because it is by far
a leader in the number of kidney transplants
using living donors.

"For people with kidney disease, this is the
best deal," said Dr. Mikel Prieto, head of M
ayo's kidney and pancreas transplant
program.

Johnson went on the transplant list two
years ago. He had had high blood pressure
most of his life, and didn't take care of it
soon enough, he said.

When his kidneys failed, he refused to ask
either of his two children to be a donor -- it
didn't feel right to him, Blomstrand said.

She was willing, but she had the wrong blood
type to be a match for her husband.

Then she heard about the kidney exchange
program.

Steffens had started a data base of local
kidney patients and donors in 2008. But it
was only when HCMC merged its pool with a
larger list managed by Johns Hopkins
University in Baltimore that Blomstrand and
Johnson were matched with a pair at the
University of Maryland Medical Center.

"The bigger the pool, the bigger the chance of
a match," said Prieto.

Johnson was matched with donor Nancy
Miller, a 44-year-old crew leader for an
electric company. Blomstrand was deemed a
match to give a kidney to Miller's partner in
the exchange, Cindy Wickesser.

In an interview this week, Miller said she
decided to be an altruistic donor -- meaning
she would give her kidney to anyone who
needed it -- when she found out that
Wickesser, the wife of a coworker, was in
kidney failure. Cooper, the surgeon,
suggested that she pair up with Wickesser in
the exchange program.

"I think it's wonderful," Miller said. "Instead
of one person getting a kidney, two people
get a kidney."

The logistics of such exchanges are daunting.
Only now are transplant centers figuring out
systems that work.

Until recently, for example, donors often had
to have surgery at the same hospital as the
recipient, which could mean traveling across
the country. That cost, which donors must
pay, and the inconvenience, has been a major
barrier.

But increasingly the kidneys do the travel --
rather than the donors -- just as they do in
the case of transplants using organs from
deceased donors.

LifeSource, the organization that manages
the deceased donor system in Minnesota,
arranged the shipping for Blomstrand's and
Miller's kidneys.

As the transplant team at HCMC waited on
Thursday, the plane from Baltimore carrying M
iller's kidney was only a half hour late.

"This went much smoother and better than I
imagined," Odland said. "As soon as the
kidney hit the door, everyone was ready to
hit the OR."

Of course, transplant centers and surgeons
also have to trust that those on the other end
will do their jobs.

"We have great faith,'' said Cooper, the
surgeon in Maryland. "But we don't know
what's going to arrive in the box when it gets
here.''

Josephine Marcotty • 612-673-7394

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