Kidney donation triggers transplant chain in San Francisco

Kidney donation triggers transplant chain in San Francisco
By Kristin j. Bender
March 5, 2015

Zully Broussard’s decision to donate a kidney started a domino effect of generosity.

SAN FRANCISCO (AP) -- Zully Broussard thought she was going to help one person by donating a kidney. Instead, she helped six.

The Sacramento woman's donation to a Benicia man set off an organ swap that resulted in five more sick people getting new kidneys at a San Francisco hospital. Three transplants were completed Thursday, and the remaining three were done Friday. "I thought I was going to help this one person who I don't know. But the fact that so many people can have a life extension, that's pretty big," Broussard said.

Domino-like kidney swaps are still relatively new, but they are becoming increasingly common. With a total of a dozen patients and donors, this week's surgeries at the California Pacific Medical Center represent the largest kidney donation chain in its transplant center's 44-year history, hospital spokesman Dean Fryer said. The patients at are between 24 to 70 years old, and most of them are from the San Francisco Bay Area.

Transplant chains are an option when donors are incompatible with relatives or friends who need kidneys. In this case, six donors are instead giving kidneys to strangers found through a software matching program, MatchGrid, developed by 59-year-old David Jacobs, a kidney recipient whose brother died of kidney failure. Its algorithmic program finds potential matches using a person's genetic profile.

Jacobs, of San Francisco, said he understands firsthand the despair of waiting for a deceased donor. "Some of these people might have waited forever and never got the kidney," he said. "But because of the magic of this technology and the one altruistic donor, she was able to save six lives in 24 hours."

Fewer than 17,000 kidney transplants are performed in the U.S. each year, and between 5,000 and 6,000 are from living donors, considered the optimal kind. Kidney swaps are considered one of the best bets at increasing live-donor transplants, and they are becoming more common as transplant centers form alliances to share willing patient-donor pairs. The United Network for Organ Sharing has a national pilot program underway.

In 2001, Johns Hopkins Hospital in Baltimore, Maryland, performed a transplant chain that started as a two-way kidney exchange and grew to 30 pairs. "When we did a five-way swap a few years ago, which was one of the largest, it took about three to four months. We did this in about three weeks," Jacobs said.

Jacobs' kidneys failed in early 2000 from a genetic disease. In late 2003, a living unrelated donor provided an organ for a transplant. A new chance at life got him thinking. "I talked to my doctor about kidney-paired donation. He was excited about the idea but didn't know how to do it," he recalled. "I was a tech person. I've been in technology my whole professional career. I thought of it as an enterprise software problem I could solve."

He said the two months he imagined it would take to take to develop the software stretched into six years. MatchGrid is catching on, growing to 24 hospitals next year. Other programs do similar work elsewhere.

"Some of these people might have waited forever and never got the kidney," Jacobs said. "Being a transplant recipient myself, I am really grateful that this software is making this possible," he said. "I understand first-hand the despair of waiting for a deceased donor." The National Kidney Foundation reports more than 100,000 people in the United States are awaiting kidneys, and 12 people die a day while waiting.

But this chain wouldn't have worked so quickly without Broussard's generosity -- or may not have worked at all. "The significance of the altruistic donor is that it opens up possibilities for pairing compatible donors and recipients," said Dr. Steven Katznelson. "Where there had been only three or four options, with the inclusion of the altruistic donor, we had 140 options to consider for matching donors and recipients."

Katznelson, who directs the California Pacific Medical Center transplant program, said Broussard had wanted to donate a kidney "some time ago" to a specific recipient, but that recipient wound up receiving a kidney from a deceased donor instead. She decided she still wanted to be a donor, and approached the hospital. "She's just an amazing person," he said, adding that Broussard is in recovery and doing well. "She's truly altruistic and almost ... ethically needed to help."

Since she has blood type O, the so called "universal" donor type, it was easier to make the chain happen, Katznelson said. "Blood type O is like gold," he told ABC News. "It really opened up a lot of possibilities."

Broussard said her son died of cancer 13 years ago and her husband passed away 14 months ago, also from cancer. Asked why she volunteered to donate a kidney to a stranger, the 55-year-old said: "I know what it feels like to want an extra day."

Source: Yahoo! AP

Kidney square dance

If a donor's kidney doesn't match up with a recipient, the two can seek out a second donor-recipient pair and trade donations.

Say, your brother needs a kidney to save his life, or at least get off of dialysis, and you're willing to give him one of yours. But then it turns out that your kidney is not a match for him, and it's certain his body would reject it. Your brother can then get on a years-long waiting list for a kidney coming from an organ donor who died. Maybe that will work out -- or not, and time could run out for him. If a donor's kidney doesn't match up with a recipient, the two can seek out a second donor-recipient pair and trade donations.

Alternatively, you and your brother could look for another recipient-living donor couple like yourselves -- say, two more siblings, where the donor's kidney isn't suited for his sister, the recipient. But maybe your kidney is a match for his sister, and his kidney is a match for your brother. So, you'd do a swap. That's called a paired donation. It's a bit of a surgical square dance, where four people cross over partners temporarily and everybody goes home smiling.

Domino effect

But instead of a square dance, Broussard's generous move set off a chain reaction, like dominoes falling. Her kidney, which was removed Thursday, went to a recipient, who was paired with a donor. That donor's kidney went to the next recipient, who was also paired with a donor, and so on. On Friday, the last donor gave a kidney to someone who has been biding time on one of those deceased donor lists to complete the chain.

Source: CNN