Stranger Kidney Swap Chain Has Potential

Organ Donation Chains Could Reduce Or Eliminate Waiting Lists For Life-Saving Procedures

(CBS/AP)  When Matthew Jones decided to donate a kidney to a stranger, the Michigan father of five had no idea he'd be starting a lifesaving, "pay it forward" chain.

His kidney donation to a Phoenix woman in 2007 set off a long-running organ swap that resulted in 10 sick people getting new kidneys over a year. It hasn't ended yet.

This chain of living donors and others like it could help increase the number of kidney transplants, lead to better matches that will increase survival and even reduce spending on costly, long-term dialysis, says the Ohio doctor behind the effort.

"My dream would be that we eliminate the waiting list because we could turn every altruistic donor into 100 transplants," said Dr. Michael Rees, a transplant surgeon at University of Toledo Medical Center.

The "paired donation" chains work like this: Someone like Jones offers a voluntary donation. The recipeint will have one good kidney and obviously can't also be a donor. But a healthy spouse, relative or friend of the recipient agrees to donate to yet another person needing a transplant.

And so on. For each recipient there is a friend or relative simultaneously donating to keep the chain going.

Rees founded the Alliance for Paired Donation, which orchestrated the now 10-person transplant chain first begun by Jones and reported in Thursday's New England Journal of Medicine.

A half-dozen other transplant groups have started similar programs, and the organization the federal government pays to oversee all U.S. organ transplants is developing its own national system.

Such efforts are needed, with the national waiting list for kidneys growing quickly due to the epidemic of overweight Americans with diabetes and high blood pressure, which damage kidneys.

Transplants from living donors accounted for more than a third of the 16,514 kidney transplants last year. Meanwhile, more than 78,000 Americans were waiting for a kidney and more than 4,000 died waiting in 2008.

Elizabeth Sleeman of the United Network for Organ Sharing, which runs the federal transplant system, cites estimates that paired donor chains could lead to 1,000 to 2,000 more kidney transplants a year.

"I think it definitely has that potential" to reduce the waiting list, she said.

Later this year UNOS plans to do a test run of matches among two-donor pairs - two kidney patients, each with an incompatible donor who matches the other patient. She hopes late by 2010 to be doing both donor pairs and chains nationally.

The program Rees started now includes more than 70 of the 244 U.S. centers with kidney transplant programs. Here's how his 10-person donor chain worked:

Jones, who lives in Petoskey, Mich., heard a news report about a man giving a kidney to a stranger and thought he'd like to do that, too. He worked with a transplant center in Buffalo, N.Y., but no match worked out.

He ultimately was referred to Rees, who was trying to devise a sophisticated living-donor pairing system. Rees' father, a computer programmer, had developed donor matching software.

It paired the 30-year-old Jones with Barb Bunnell, a 53-year-old Arizona woman whose husband wanted to donate a kidney but was incompatible.

Ignoring pleas from relatives to think of his children and drop the idea, Jones flew to Arizona for medical tests, taking his wife Meghan with him. Her staunch opposition vanished once she met Bunnell.

Just after the July 18, 2007 surgery, Jones recalls feeling "like a truck had run over me." But he was well enough to go to a Diamondbacks baseball game five days later. The cost of the surgery and Jones' travel were paid by Bunnell's insurance.

Bunnell's grateful husband, Ron, then became what Rees believes is the world's first "bridge" donor, meaning his kidney donation was made later. Usually, paired transplants are done at the same time, with relatives agreeing to donate a kidney to a compatible stranger in exchange for a kidney for their loved one. That way donors can't back out.

Such reneging hasn't happened in his chains, Rees said.

Ron Bunnell was on a plane a week later to give his kidney to a 32-year-old Toledo woman, Angie Heckman. She's a waitress at a bar owned by her mother, Laurie Sarvo. Sarvo then gave a kidney to a woman in Columbus, Ohio, whose daughter then became the fourth donor in the chain.

On it ran, through patient-donor pairs including two more married couples, siblings, a daughter and father, and two friends. The last operation was done last March, with a 60-year-old woman in Toledo getting a kidney from a Baltimore donor. That recipient's daughter wants to donate a kidney, but a match hasn't worked out yet.

"There's a very good possibility that when I'm dead and gone, this chain will still be going on," Jones said.

[puzzler125]

I'm curious about the percentage (and I'm sure it's low) of kidney donors who need extra medical care, including possibly their own kidney transplant, years later.

[gold_standard]

It is legal to donate a kidney for free, and fortunately there are altruistic people who do so.

It is illegal to donate a kidney in exchange for money because some people think it distasteful.

I would gladly sell a kidney to make sure my kids could go to college and my wife had a nest egg for the future. The odds are it would never hurt me, and even if I died someday as a direct result, it would be worth it.

And the risk is the same whether you donate the kidney for free or get paid for it. So why can you donate a kidney for free, but you cannot get paid for it? Why do we condemn people to death who need a kidney just because we demand that it be free?

There would be no shortage of kidneys if people were allowed to buy and sell them. You can argue with me all you want about why I should not sell a kidney, but the person who needs the kidney is going to die. Do not argue with me--go tell that person they deserve to die and see how good you feel about it.

We don't need to put people on a guilt trip to get enough organ donations. All we need to do is open the market and plenty of people will gladly step forward. Is it really noble to try to get an organ donation for free? Sounds selfish to me. Is it really ethical to condemn a person to death if they cannot get an organ for free? Sounds barbaric to me.

If organ donations have to be free, then we must think life is cheap.