A Daisy Chain of Kidney Donations

By RHONDA L. RUNDLE The Wall Street Journal

Pamela Heckathorn received a kidney from an anonymous donor on July 30. The operation not only allowed the 51-year-old to avoid dialysis treatments; it also kicked off a chain of transplants that have benefited a number of other kidney patients.

Ms. Heckathorn, a public-school employee in Cypress, Calif., had originally planned to accept a kidney offered by a cousin, but the two had turned out not to be biologically compatible. Before Ms. Heckathorn's surgery, the cousin donated his kidney anyway to another patient. That patient, in turn, also had a willing donor who was incompatible. So that donor's kidney was handed off to yet another patient.

So far, three kidneys have been transplanted as part of the chain that included Ms. Heckathorn. The latest recipient's son has agreed to keep the chain going by donating one of his kidneys as soon as another compatible recipient can be found.

All the transplants were performed at Ronald Reagan UCLA Medical Center in Los Angeles by surgeons who believe that such chains of donations have the potential to save hundreds, or even thousands, of lives by making more organs available for transplant.

"This is one of the most exciting things I've been involved with in 30 years in this field," says Gabriel Danovitch, director of UCLA's kidney and pancreas transplant program.

Kidney chains are an extension of kidney swaps, a practice that has led to hundreds of additional live organ transplants in recent years. A swap occurs between two or more sets of incompatible recipients and donors, who are usually family members. If a donor's organ isn't compatible with a loved one who needs a kidney, doctors are able to swap that organ with one from another incompatible pair. Swap operations are usually performed simultaneously at the same transplant center to avoid a situation where one of the donors backs out at the last moment.

Transplant chains have the potential to help many more kidney patients than swaps, medical experts say. A chain starts with an altruistic individual who wants to donate a kidney to help a stranger in need. The anonymous donation goes to a recipient who has lined up a living donor, but who isn't biologically compatible. In turn, that donor's kidney can benefit other patients who have also lined up living donors who ended up being incompatible, each time passing an extra kidney down the line.

The Honor System

In theory, a chain could continue indefinitely, broken only by an event such as a donor backing out. Surgeons say that so far they aren't aware of any case of that happening. "It's all on an honor system; there's no legal means to ensure that it happens," says David Serur, medical director for the transplant program at NewYork-Presbyterian/Weill Cornell Medical Center.

Transplant surgeries can be done sequentially, rather than at the same time, allowing more than one medical center to participate. But many transplant centers aren't sold on the idea of chains. In sequential transplants, there's an increased chance that a would-be donor might be injured or get sick or otherwise be prevented from donating. Some of the chains stretch across the country, and long-distance shipping of organs increases the possibility of a travel delay or damage to the organ.

"There's no fundamental ethical dispute, but I have had reservations [about chains] because I would like to see transplants finalized and completed," says Frank Delmonico, a transplant surgeon at Massachusetts General Hospital in Boston.

Michael Rees, a transplant surgeon at Ohio's University of Toledo Medical Center, is credited with having launched the first kidney chain last year through the Alliance for Paired Donation, a nonprofit he founded. That chain has resulted in 10 transplants so far, involving six separate transplant centers. A second chain Dr. Rees helped initiate is three surgeries long, and a third chain is set to start next month, he says. The National Kidney Registry, a computerized matching service, says it has launched three chains with a total of 11 transplants, and has six more chains that are due to start up soon. The kidney registry was set up last year by a New York businessman whose daughter, now 12 years old, received a kidney transplant.

"The way the math works in chains, there's potential for many more people to get transplants" than the current undersupply of donated kidneys allows, says Elizabeth Sleeman, a policy analyst at the United Network for Organ Sharing, or UNOS. The nonprofit group contracts with the federal government to allocate organs from deceased donors. UNOS is studying transplant chains as part of a broad plan to extend its operations to living donors, possibly as early as the end of next year.... Read the full article.

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