Live-Donor Kidneys Withstand Long-Distance Travel

By Jody A. Charnow Renal & Urology News

Allografts flown coast-to-coast were transplanted successfully despite prolonged cold ischemia

Shipping live-donor kidneys to transplant centers over long distances—even transcontinentally—does not adversely affect recipient outcomes, a recent experience involving four transplant centers suggests.

Investigators presented details of a chain of eight donor- exchange transplants facilitated by three transcontinental shipments and one intrastate shipment of live-donor kidneys. The four shipped kidneys were all packed in ice and then transported, unaccompanied, by commercial airlines to the recipients' hospitals with local Organ Procurement Organization involvement. These kidneys were transported and transplanted without incident, said Fauzia K. Butt, MD, a transplant surgery fellow and clinical instructor at the University of California in Los Angeles (UCLA). At three to six months post-transplant, all allografts were functioning well, said Dr. Butt, who was involved in the first transplant.

The chain was initiated by an altruistic donor in New York, who underwent a laparoscopic donor nephrectomy at the New York Presbyterian-Weill Cornell Medical Center. That kidney was then packed on ice, taken by courier to the airport, and flown by commercial jet to Los Angeles for transplantation at UCLA. The kidney had 14 hours of cold ischemia prior to transplantation. “However, it produced urine immediately in the OR upon reperfusion,” Dr. Butt stated. She added: “The kidney showed absolutely no signs of jet lag. It acted as if it had taken a journey from the OR next door, not a trip across the country.” At six months post-transplantation, the recipient's serum creatinine level was 1.2 mg/dL and she was doing well.

Additional kidneys were transported from Los Angeles to Palo Alto, Calif., for transplantation at Stanford University, from Palo Alto to New York for transplantation at New York Presbyterian-Weill Cornell Medical Center, and from New York to San Francisco for transplantation at California Pacific Medical Center. The cold ischemia times for these kidneys were 8, 12, and 11 hours, respectively. The recipients serum creatinine levels at three months were 1.5, 1.3, and 1.7 mg/dL, respectively.

“This experience demonstrates that it is not necessary to transport the donor, as is customary, but that transportation of living donor kidneys is a viable option, similar to what is routinely done for deceased donor kidneys on a daily basis,” Dr. Butt told Renal & Urology News. “If individuals can be spared traveling long distances to the recipients' transplant centers in unfamiliar surroundings, they could recover from their surgery amongst friends and family and additional people might be inspired to become live donors. The results would be an expansion of the donor pool with quality living donor kidneys.”

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In-laws crowd organ donor list in India

by Jinal Shah iexpressindia.com

Mumbai Doctors overseeing organ transplants across the state have found a worrisome detail: a large number of kidney transplants in Maharashtra where the donor is not a relative of the patient involve donation of the organ by a wife’s parent or sibling.

“We have got about 32 to 40 cases a year where male patients have a parent-in-law or a brother-in-law or sister-in-law as donor,” said Dr Pravin Shinghare who heads the state-level authorisation committee for organ transplants. The committee must give its nod to all transplants where the donor is not an immediate relative.

“This amounts to 40 to 50 per cent of cases where the donor is not a relative,” Shinghare said. He added that in most such cases, recipients bring certificates to the committee to prove that their biological parents are medically unfit to donate.

Every year, Maharashtra sees 150 to 175 live kidney transplants, and approximately 80 of these involve donors who are unrelated to the patient. The state authorization committee is entrusted the task of finding the motive behind the transplant. While women’s rights groups said it is alarming if the numbers were accurate, the authorization committee says this is simply an observation, for now.

Doctors began to see how common such a practice is when a recent suggestion from the Maharashtra committee on amendments to the Transplantation of Human Organs Act (THOA), 1994, was turned down by the Centre. The suggestion had been to include uncles and aunts in the list of “near relatives” who could be donors. Currently, near relatives — mother, father, brother, sister, spouse, son and daughter — can directly donate organs at the hospital level without having to approach the authorization committee.

The suggestion was rejected since experts felt it could expose the wife’s family to undue pressure for donating an organ to a recipient in the groom’s family.

However many nephrologists in the city think otherwise. “There are many in-laws who are altruistic donors. Also, Indian families are very closely knit. Some percentage of undue pressure should not stop the state from widening the ambit of near relatives to uncles and aunts and even to in-laws with altruistic intentions,” said Dr Umesh Khanna consultant nephrologists at Asian Heart Institute and chairman of the Mumbai Kidney Foundation. This would help reduce the instances of commercial transplants, he added.

“You Have the Power to Save Lives – Sign Your Donor Card & Tell Your Loved Ones of Your Decision”

Register to be a donor in Ontario or Download Donor Cards from Trillium Gift of Life Network
For other Canadian provinces click here

In the United States, be sure to find out how to register in your state at ShareYourLife.org or Download Donor Cards from OrganDonor.Gov

In Great Britain, register at NHS Organ Donor Register

In Australia, register at Australian Organ Donor Register

Your generosity can save up to eight lives with heart, kidneys, liver, lungs, pancreas and small intestine transplants. One tissue donor can help up to 100 other people by donating skin, corneas, bone, tendon, ligaments and heart valves

Family gives father gift of life -- twice

Paul Miller, center, his wife Andrea, left, son David.

By Nick Heynen Wisconsin State Journal

When Paul Miller needed a new kidney in 1999 as the cysts that had plagued him for 20 years began to win the battle, his wife didn't hesitate to volunteer one of her own.

She looked at her husband, saw how weak he was becoming, and said to herself, "Whatever it takes to make him better, that's what I (want) to do." She underwent tests, turned out to be a match and gave her husband one of her kidneys.

Nine years later, as Paul Miller's 61-year-old body gradually rejected the kidney, his son David Miller, 34, followed his step-mother's example. He and his father completed the second kidney transplant for this tight-knit family on Dec. 11 at the University of Wisconsin Hospital in Madison.

Having two family members donate kidneys to a transplant patient over several years is unusual but not unheard of, said Dr. Yolanda Becker, a UW Hospital transplant surgeon.

For Andrea Miller, the decision was an easy one.

She'd been reading up about kidney transplants so she knew that organs from living donors last longer than those taken from cadavers and that waiting for a donor could take two or three years.

Still, she'd had surgery before and it had been a bad experience. And she knew the operation — an open surgery, not commonly used for kidney transplants anymore — would come with the risk of large scars, hernias, chronic pain and a long recovery period.

The result proved to be well worth the risk. Her husband showed almost immediate improvement. In his words, "it was like a light switch" had turned on inside him. "It was just like being a different person," he said.

In fact, when she awoke shortly after the surgery, Andrea Miller said, she was "in dire straits." But her husband was already there, sitting by her side.

"I said, 'What are you doing here?' " she laughed. "He was feeling like a million bucks."

Just a few months after it became apparent his father would soon need another transplant, David Miller, his wife, Dana, and their children, 6 and 7, faced another big scare: an MRI scan showed a tumor in Dana's brain. She would have to have surgery to remove it, and soon.

Yet he remained steadfast in his decision to help his father.

"Don't get me wrong, at times I was a wreck," he said. "I just went back to: All other things being equal, I'm still going to do this. I still think it's important."

Dana Miller's tumor turned out to be benign and her surgery was a success.

A few months later, father and son went through the transplant surgery. Doctors performed the surgery laparoscopically, which is less invasive and carries fewer risks than the open-incision procedure Andrea Miller underwent years before.

It was another success, although Dana Miller jokingly pointed out that she's now in charge of removing the snow from the walk while her husband recovers.

Again, Paul Miller's recovery was swift. He was out of the hospital in three days, although his surgeon, Dr. Josh Mezrich, said he looked like he was ready to go home within an hour of the surgery. The kidney was a good match and his prognosis is good, Mezrich said.

"There's no reason to think that he can't do well for a very long time," he said.

Paul Miller's hands, still splotched with purple bruises from all the IVs, still shake slightly when he cuts into his morning pancakes, but the wheelchair he once needed now sits in the trunk of the car. His wife said she plans on returning it soon.

"I don't know a better blessing a father could have," he said of his family's generosity.

He and his family are grateful for lots of other things: for the insurance company that covered almost all the costs of both transplants, for the staff in the transplant ward at UW Hospital who made the unbearable a little less so, and for the friends, coworkers and family who came to talk and to help out.

And should he need another kidney some day, his experience over the past 10 years has shown him that he has a wealth of good will to draw on. His two other children also offered up kidneys this year, as have numerous other family members and friends. Even his regular UPS delivery man offered to get tested back when he first needed a transplant.

"We have a lot to be thankful for," Andrea Miller said.

"Here's to a really boring 2009," added her husband.

“You Have the Power to Save Lives – Sign Your Donor Card & Tell Your Loved Ones of Your Decision”

Register to be a donor in Ontario or Download Donor Cards from Trillium Gift of Life Network
For other Canadian provinces click here

In the United States, be sure to find out how to register in your state at ShareYourLife.org or Download Donor Cards from OrganDonor.Gov

In Great Britain, register at NHS Organ Donor Register

In Australia, register at Australian Organ Donor Register

Your generosity can save up to eight lives with heart, kidneys, liver, lungs, pancreas and small intestine transplants. One tissue donor can help up to 100 other people by donating skin, corneas, bone, tendon, ligaments and heart valves

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.

“You Have the Power to Save Lives – Sign Your Donor Card & Tell Your Loved Ones of Your Decision”

Register to be a donor in Ontario or Download Donor Cards from Trillium Gift of Life Network
For other Canadian provinces click here

In the United States, be sure to find out how to register in your state at ShareYourLife.org or Download Donor Cards from OrganDonor.Gov

Your generosity can save up to eight lives with heart, kidneys, liver, lungs, pancreas and small intestine transplants. One tissue donor can help up to 100 other people by donating skin, corneas, bone, tendon, ligaments and heart valves

Single-incision surgery is boon to organ transplants

This exciting new technique may bode well for the thousands of patients waiting for a kidney transplant. Potential living donors who were reluctant to go through with it due to the long recovery time for traditional surgery may now be willing to be a donor.

From The Plain Dealer, Cleveland, Ohio:

By Angela Townsend
By year's end, virtually all kidneys removed for donation at the Cleveland Clinic will be removed through a single incision at the belly button.

That's Dr. Inderbir Gill's prediction.

He should know. Since November, the chairman of the urology department at the Clinic's Glickman Urological and Kidney Institute has performed the operation 11 times, most recently on Thursday, after which he said, "It went beautifully."

More than 90 percent of donor kidneys in the U.S. are now removed with standard laparoscopic techniques that have been around for more than a decade.

"As people become more familiar and comfortable with it, and as our data is substantiated by others, virtually all will be done single port," said Gill, who is currently training other Clinic physicians in the new technique. "Patients are going to drive this technology."

That could mean more people -- previously turned off by the long recovery time -- willing to become kidney donors.

More than 80,000 Americans are awaiting kidney transplants.

Last year, there were about 13,300 kidney donors in the United States, and about 45 percent were living donors, according to the Organ Procurement and Transplantation Network. Gill's single-incision patients, and the recipients of their kidneys, have recovered well. "So far, we have not had any complications," he said.

A report on the first four patients appears in the August issue of the Journal of Urology. Preliminary data from the first nine donors showed they recovered in just under a month, and have been going back to work sooner than that, in about 17 days. Donors who underwent the traditional laparoscopic procedure with four to six small incisions at the abdomen took just longer than three months to recover, and returned to work in 51 days.

The method takes advantage of the belly button to avoid a visible scar... Read the full story.

“You Have the Power to Save Lives – Sign Your Donor Card & Tell Your Loved Ones of Your Decision”

Register to be a donor in Ontario or Download Donor Cards from Trillium Gift of Life Network
For other Canadian provinces click here

In the United States, be sure to find out how to register in your state at ShareYourLife.org or Download Donor Cards from OrganDonor.Gov

Your generosity can save up to eight lives through organ donation and enhance another 50 through cornea and tissue donation