Two compatible pairs: Paired kidney exchange

Thanks to a new program, a Georgia man and a Bessemer, Alabama, woman who both expected to wait many years for kidney transplants received new organs. More than a year ago, they were the first patients to receive a paired kidney exchange that matches a patient who has a willing, healthy living donor — sister and fiancé, respectively, in this case — with another donor and recipient, forming two compatible pairs.

The donors and recipients: Recipient James Thorn Jr., 38, of Bainbridge, Georgia, and his sister, Cynthia Rayburn, 42, of Jefferson County; and recipient Dwana Lewis, 29, and her fiancé, Alex Caldwell, 40, both of Bessemer. In the exchange, Cynthia donated to Dwana and Alex donated to James.

This was the first such procedure performed at the University of Alabama. All patients were recovering well and are listed in Good condition, transplant surgeon Alex Hawxby said. The recipient patients James and Dwana were to be discharged from the hospital within a few days while their immune-suppressing medications were being adjusted.

In such a procedure, both pairs of patients initially are kept anonymous from each other. When admitted to the hospital, they are assigned to different nursing units, go to different pre- and post-operative areas and return to separate nursing units afterwards. Their families wait in different areas, also.

To prevent any possibility that one of the donors might back out of the operation at the last moment, all the patients are simultaneously put under anesthesia.
Matching the appropriate incompatible pairs is a complex undertaking that requires additional staff and operating rooms, and a carefully choreographed operating room process, according to Dr. Eckhoff, who is director of the UAB Division of Transplantation. "The UAB Transplant Program has committed considerable resources for this program because of its great potential to provide relief to many of our patients," he said.

National Kidney Foundation President David G. Warnock, who is director of the UAB Division of Nephrology, noted: "This development marks an important milestone in the ongoing growth of the UAB transplant program. It will broaden the choices of patients with chronic kidney disease who are needing living donors for transplantation."
Nationally, the number of donated kidneys coming from living donors has increased dramatically in the last decade, as kidney-failure patients realize that the number donors available through organ banks is not rising by much. Family members and other loved ones may want to volunteer to donate one of their kidneys, but frequently are turned down for medical reasons. Others are told they cannot donate to their relative or friend because they have tissue characteristics that are incompatible or because the patient's blood contains proteins that would cause the kidney to be rejected.

UAB transplant doctors hope the Living Incompatible Kidney (LINK) transplant program will reduce long waiting times and help ease the organ shortage. Dr. Hawxby said, "As many as a third of patients are incompatible with their potential living donors. With the new paired kidney exchanges through LINK, a donor freely offers a kidney to a stranger in order to get their own loved one transplanted by another donor with a reciprocal situation. Many dialysis patients are on our transplant waiting list, which is why that list now numbers more than 2,400, with waiting times for transplants of typically four to five years and sometimes more."

Several more paired kidney exchanges are being evaluated.

Drs. Hawxby and Mark H. Deierhoi led James' operation, and Drs. Devin Eckhoff and Harry Sun led Dwana's surgery.

Advice to those needing a kidney: Look into innovative programs of kidney exchange like this one.

Browse for similar stories in our index at the very bottom of this page, or read a kidney transplant story.

Thanks to Hank Black of the University of Alabama for the source story.