'Kidney swaps' between strangers offer new life

'Kidney swaps' between strangers offer new life
New matching software aims to shorten agonizing wait.

By Barbara Anderson / The Fresno Bee
05/17/07 04:58:01

Gretchen Freedman needed a kidney.

Trips three times a week for dialysis were getting harder to take physically and emotionally. The sessions to filter toxins from her blood sapped her strength, gave her headaches, made her dizzy and sick to her stomach.

But the wait to get a donated kidney from a deceased person could be as long as five years.

Freedman's sons, Ryan and Jarod Ramirez, didn't know how much longer their mother could tolerate dialysis. Each volunteered to donate a kidney.

After blood screenings and tests, Ryan Ramirez, 29, gave up a kidney -- but not to his mother.

Instead, on Feb. 14, Ramirez's healthy organ went to a man he'd never met, and his mother received a kidney from the stranger's daughter. It's an example of a new transplant option known as a "kidney swap" or paired kidney donation.

Such swaps could make a dent in the long waiting lists for kidney transplants, experts say, although it could be a few years before the procedure becomes routine.

In a kidney swap, two donors and two patients are cross-matched so kidneys can be exchanged and each patient gets an organ that is compatible.

Ramirez's kidney wasn't a good match for his mother, but it was for the man whose daughter's kidney was compatible with Freedman, 55.

Freedman and Ramirez couldn't be happier with the results of their kidney swap. Said Freedman: "The final outcome is two people benefited -- and how neat is that?"

She wanted to thank her kidney donor and meet the man who received her son's kidney after the transplant, Freedman said, but the donor-recipient pair preferred to remain anonymous.

Paired kidney donations are relatively new in the United States. To date, between 70 and 100 have been performed in the U.S. Kidney-exchange programs are more established in countries such as Korea and the Netherlands.

Freedman and Ramirez's kidney swap was the first west of the Mississippi using new computer software to find hard-to-match pairs, said Dr. Steven Katznelson, medical director of the kidney and pancreas transplant programs at California Pacific Medical Center in San Francisco, where the swap was done.

California Pacific hopes to do paired kidney donations every month or two, Katznelson said. Since February, the hospital has done seven transplants by kidney exchange.

Paired kidney donations are becoming more common nationwide, said Dr. Mark Stegall, chairman of the transplant kidney committee for the United Network for Organ Sharing/Organ Procurement Transplant Network, which coordinates organ-transplant activities.

Such donations could increase the number of kidneys available nationwide by several hundred in the next two or three years, "and that's a good thing," Stegall said.

About 6,000 transplants are done with living donors each year, he said.

About 40% to 50% of people who are willing to donate are told they cannot for reasons such as incompatibilities with the recipient or physical health problems.

The door for more kidney exchanges opened wider in March, when the U.S. Justice Department said kidney swaps were legal and an exchanged kidney did not equate to acquiring an organ in exchange for "valuable consideration," such as money, which is illegal.

In the past year, Stegall said the UNOS kidney committee has worked on a proposal that would create a national list of paired donors and recipients. Transplant centers in some states have such lists, but there is no national paired donation data bank.

"The more pairs you have to choose from, the more people will get transplants," Stegall said.

The typical kidney transplant patient waits three to five years for an organ from a deceased donor. More than 71,000 people are on the waiting list for kidney transplants in the United States.

Organs from living donors have advantages over those from deceased donors, Katznelson said. Kidneys from living donors last on average almost 20 years -- which is 50% longer than those from deceased donors, he said.

Ramirez, 29, said he didn't hesitate to agree to donate his organ to a stranger if it meant his mother would get a kidney. Likewise, the man's daughter consented to give her kidney to Freedman if it ensured her father a transplant.

In his mind, Ramirez said his kidney went directly to his mother. "It was because of her that I did it."

Ryan, a real-estate salesman, and his brother Jarod Ramirez, 26, a home builder, had known since they were teenagers that one day one of them would donate a kidney to their mother.

Lupus, a chronic inflammatory disease, had destroyed Freedman's kidneys. In 1987, she received a kidney from a deceased man whose organs were donated.

But by 2004, her donated kidney was failing and so was Freedman's health. She had to take a medical leave from her job as a Fresno Unified school psychologist.

"We all knew the day was going to come where her kidney was just going to wear out," Jarod Ramirez said. He was days away from giving his mother a kidney when the transplant was called off. A final test showed his kidney would not be compatible with his mother.

Ryan Ramirez appeared to be the better donor. But his kidney was not the best choice for Freedman. The family was given the option of a paired kidney donation.

Katznelson said word is spreading about paired kidney donations, as more of the procedures are being done around the country. Freedman and Ramirez watched a television program about a kidney swap before undergoing their own operations.

Albert Fernandez, 45, of Easton, sees paired kidney donation as a choice for his mother-in-law, Frances Segura, 66, of Fresno.

Segura has diabetes and is facing dialysis if she cannot find a donor soon. The family is posting fliers around Fresno, asking for a volunteer donor. Fernandez is not an ideal match for Segura, but he is willing to donate a kidney in exchange for one for his mother-in-law if a compatible donor cannot be found.

"If there's a way to help someone extend their life, this is an easy way," he said.

Finding donor-recipient pairs for kidney swaps isn't a simple process. It takes a computer to crunch millions of variables to cross-match people for blood types and proteins on blood cells that are compatible for a kidney swap.

The new software used by California Pacific made the kidney exchange possible for Freedman and Ramirez.

The computer program, named Silverstone Matchmaker, was created by David Jacobs, 51, a San Francisco software engineer who received a kidney transplant in December 2004.

Jacobs' transplant came from a living, unrelated donor. But he was on dialysis for a number of years "and was not in good shape when I was transplanted," he said.

Jacobs said he hopes his computer system can get more people off the transplant waiting list by enabling hospitals to do paired kidney donations regularly.

"I would like to make it not a novel thing," he said. "It should be standard operating procedure in the hospital to have this option for people."

Freedman said paired kidney donation is an avenue of hope for people on the organ waiting list.

Every day with her new kidney, she feels stronger, she said. "Now, I have a future with my family."

The reporter can be reached at banderson@fresnobee.com or (559) 441-6310.

More information
ON THE WEB

United Network for Organ Sharing: www.unos.org

National Kidney Foundation: www.kidney.org

Alliance for Paired Donation: www.paireddonation.org

North American Paired Donation Network: www.paireddonation network.org

PHOTO: Gretchen Freedman needed a kidney, and her son Ryan Ramirez was willing to donate one to her. He wasn't a match for his mother, but he was a match for another person, which led to a "paired" match for his mother.