The Kidney Swap: Adventures in Saving Lives
Norman Y. Lono for The New York Times
By DENISE GRADY and ANAHAD O'CONNOR
Published: October 5, 2004
TIMES NEWS TRACKER
His eyes on a video monitor that displayed the inside of Suzanne DeCample's abdomen, Dr. Lloyd Ratner gently guided a hollow rod through an incision below her navel. Watching his progress on the monitor, he advanced the tool toward her left kidney and then passed another instrument, tipped with a plastic bag, through the rod.
One of his favorite CD's played softly in the background, the Jackson Five singing "ABC, easy as one, two, three."
"Getting jiggy with it," Dr. Ratner said, as he captured the kidney in the bag, plucked it out and handed it off to another surgeon, who slid it from the bag into a gauze-covered ice bath.
In the operating room next door, surgeons were preparing Ms. DeCample's brother, Buddy, for a transplant. He is 41; she is 40.
But Ms. DeCample's kidney was not headed for her brother. Instead, it was going to a stranger, Debbie Barnett, 40. Mr. DeCample also got a transplant, but from Ms. Barnett's stepmother, Jane Thomas, 54, whom he had never met. All four operations were carried out simultaneously last Wednesday morning in neighboring operating rooms at New York-Presbyterian Hospital/Columbia University Medical Center.
The reason for this kidney swap, or "paired exchange," was simple: to lower the risk of rejection, kidney donors and recipients must have compatible blood and tissue. Ms. Barnett and Mr. DeCample did not match their own relatives, but each had a match in the other's family. When a transplant coordinator saw their medical records and told the two families they might be able to help each other, they seized the opportunity.
The surgery was carefully choreographed to meet two conditions: the families could not meet or even know one another's names beforehand, and all four operations had to be done at the same time, to make sure no one backed out.
"If it weren't like this, I could give my kidney up and the other donor could just walk out and not go through with it," Ms. DeCample said.
The idea of swapping kidneys may sound bizarre, but it makes perfect sense to people who are willing to donate a kidney to help a loved one get free of dialysis. A healthy person can safely give up a kidney, and last year 6,468 kidney transplants came from living donors. But family members do not always have compatible blood or tissue.
When relatives want to donate but do not match, kidney exchanges between families can help patients avoid long waits on the transplant list and the serious decline in health that often occurs in people who are on dialysis for years at a time. In the United States, 60,000 people are on the waiting list for a kidney, but last year only 15,000 got transplants. In the New York area, the wait is about seven years.
In regions with long waiting times, kidney exchanges may save lives.
In 2001, Dr. Ratner, then at the Johns Hopkins Hospital in Baltimore, and other surgeons performed the first kidney swap in the United States. Since then, about a dozen more have been performed there, including two six-way swaps that each involved three families. The recipient's insurance usually pays for the donor's expenses.
Only a handful of other swaps have taken place at hospitals around the country, Dr. Ratner said, in part because the procedure requires a transplant program with enough staff to find matching families and perform four operations at once.
Transplant experts are trying to develop a nationwide system to coordinate kidney swaps, but, Dr. Ratner said, "I suspect that realistically, before all the details are worked out, it will be two years before it's up and running."
The leading causes of kidney failure are diabetes, high blood pressure and a group of kidney diseases called glomerulonephritis. Diabetes rates are increasing, and by 2010, about 100,000 people in the United States will be on the waiting list for kidney transplants, Dr. Ratner said.
"We need novel strategies to make optimal use of live donors," he said.
When doctors at Johns Hopkins first considered paired exchanges, they consulted lawyers about ways to make sure that one side did not renege after the other had already given up a kidney, Dr. Ratner said. The lawyers ruled out a contract because, he said, "you can't contractually oblige someone to undergo surgery if they change their minds."
The group concluded that the only way to protect patients from being cheated out of a transplant was to put them all under anesthesia at the same time so that no one could back out.
Continued
http://www.nytimes.com/2004/10/05/health/05kidn.html?_r=1&oref=slogin
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