Canadian woman part of longest kidney transplant chain

By BARBARA TURNBULL, LIFE REPORTER healthzone.ca

Josephine Bonventre wanted to donate a kidney to an American cousin. It wasn't a perfect match but she became part of a 60-person transplant chain and her cousin got the kidney he needed.

When Toronto realtor Josephine Bonventre discovered a distant cousin needed a transplant, she decided almost instantly to donate a kidney.

Her blood is Type O making her a universal donor and compatible with her cousin Cesare Bonventre’s Type B blood. But the tile worker in Brooklyn, NY, had anti-bodies which made the match less than ideal.

It was this non-perfect match that lead Bonventre to participate in a 60-person kidney transplant chain that took place last year in the U.S. — the longest in history.

Kidney transplant chains shorten the wait for wellness

When her cousin first asked her to donate that kidney to a stranger, to enable him to get a better match from someone else, she needed to sleep on it, she says, reflecting on the unusual circumstances. Though her family was supportive of her decision to donate to her cousin — even though he was her fifth cousin, lived across the border and was someone she didn’t know well – they were not on board with the turn of events. They urged her to think of her two children; they suggested she didn’t know what she was getting into.

“I woke up with fresh thoughts and thought `Why not give it to a stranger? I’ll be helping another person and he’ll be getting a match that’s better for him,’” she says nearly three months after the transplant took place.

And so Bonventre, 41, became part of Chain 124, the longest chain of kidney transplants ever constructed, linking 30 willing donors with 30 recipients who needed the life-saving procedure. The extraordinary story was chronicled in The New York Times last weekend. All but one of the 60 people involved agreed to be identified for the story. Ordinarily strict confidentiality keeps donor and recipient apart.

The domino chain of 60 operations began with one Good Samaritan, a California man named Rick Ruzzamenti, who after hearing of someone who donated a kidney to an ailing friend, made an impulsive decision to donate too. Four months, 17 hospitals and 11 states later, Donald C. Terry Jr., of Joliet, Ill., who had no one in his circle able or willing to donate, received the kidney that completed the chain.

Bonventre went to Brooklyn for preliminary testing, went back one week prior to surgery and stayed for 10 days afterward. One month later, she checked in with her family doctor. The only other involvement of the Canadian medical system was having blood drawn and sending the results to the Brooklyn transplant center.

She needed a month to recover fully, but the procedure was a resounding success. “He feels fantastic,” Bonventre says. “He has more energy than he’s had in a long time.”

And her?

I’m good. It’s surreal, like it never happened,” she says. “I feel 100 per cent normal.”

The experience was life changing in the best possible way, she says. “It’s totally worth it.”

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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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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

Donors and kidney transplant patients matched using new computer models

Virtualmedicalcentre.com

New computer models can now link strangers in a life-saving chain of kidney transplants, promising to increase the number of transplants and overcome obstacles posed by logistics or donors who renege, a team of researchers report in the current edition of the New England Journal of Medicine.

Designed to optimise the "matching market" principles involved in kidney transplantation, donor registry software programs sift through thousands of pairs of recipients and their living donors, analyse participant characteristics, then construct an optimal chain of transplant pairs, report the co-authors, many of whom helped pioneer the creation of donor chains.

For the approximately 70,000 US patients in need of a kidney transplant, the data-driven approach to transplantation pairings should shrink the rolls of patients on waiting lists.

The donor chains start with a single "altruistic" volunteer donor.

"The Good Samaritan who comes forward to donate a kidney serves as the catalyst for a series of donations in a much more efficient system," says Boston College Assoc. Prof. M. Utku Unver, a theoretical economist. "It is not an easy decision to give up a kidney to help a stranger. These advances may encourage more donors because they now know they can save many lives."

The approximately 4,000 living donor kidney transplantations that take place in America each year rest upon a fragile balance of donors and recipients engaged in a "matching market" where volunteers provide life-saving organs without monetary compensation, says Unver, who has been examining kidney exchange for five years.

The computer-generated chains provide a viable alternative to the relatively new strategy of paired donation, where organs are exchanged between two donor-recipient pairs during simultaneous surgeries.

Paired donations are prone to breakdowns because a willing donor is not a compatible match, a recipient is too far away or a donor backs out of the extremely personal transaction.

Unver and his fellow researchers highlight a chain of kidney transplantations that started with a 28-year-old Michigan man in July of 2007 and led to 10 transplantations coordinated during 8 months by two large paired-donation registries, the 25-state Alliance for Paired Donation and Incompatible Kidney Transplantation Program at Johns Hopkins Hospital.

The transplantations took place at six medical centres in five states. Three kidneys from living donors were shipped – two using commercial flights – rather than requiring donors to travel to the recipient's hospital.

The computer models assign values to the characteristics of donors and recipients stored in massive databases. The programs then generate pairings based on with similar scores, imposing an order on these exchanges by overcoming issues that disrupt a market.

"Economists have been looking at solving the 'mechanism design' problem of paired donations by using data to increase efficiency," says Unver, whose early work on these models with fellow BC economist Tayfun Sonmez led to the founding of the New England Program for Kidney Exchange. "As work progressed, people began to see this was a way of overcoming the problems involved with paired donations."

Paired kidney donation surgeries are performed simultaneously to reduce the possibility of a donor backing out once a friend or relative has received a kidney.

A donation chain allows for greater flexibility, since not all surgeries must take place at the same time in the same hospital.

The researchers conclude further that kidney donor chains could shorten wait times on lists of unmatched patients in line for deceased-donor organs. The scope of the databases can pair these patients with suitable living donors, who account for approximately one-third of the 14,000 kidney transplantations that take place annually in the US.

(Source: Boston College: New England Journal of Medicine: March 2009)New computer models can now link strangers in a life-saving chain of kidney transplants, promising to increase the number of transplants and overcome obstacles posed by logistics or donors who renege, a team of researchers report in the current edition of the New England Journal of Medicine.

Designed to optimise the "matching market" principles involved in kidney transplantation, donor registry software programs sift through thousands of pairs of recipients and their living donors, analyse participant characteristics, then construct an optimal chain of transplant pairs, report the co-authors, many of whom helped pioneer the creation of donor chains.

For the approximately 70,000 US patients in need of a kidney transplant, the data-driven approach to transplantation pairings should shrink the rolls of patients on waiting lists.

The donor chains start with a single "altruistic" volunteer donor.

"The Good Samaritan who comes forward to donate a kidney serves as the catalyst for a series of donations in a much more efficient system," says Boston College Assoc. Prof. M. Utku Unver, a theoretical economist. "It is not an easy decision to give up a kidney to help a stranger. These advances may encourage more donors because they now know they can save many lives."

The approximately 4,000 living donor kidney transplantations that take place in America each year rest upon a fragile balance of donors and recipients engaged in a "matching market" where volunteers provide life-saving organs without monetary compensation, says Unver, who has been examining kidney exchange for five years.

The computer-generated chains provide a viable alternative to the relatively new strategy of paired donation, where organs are exchanged between two donor-recipient pairs during simultaneous surgeries.

Paired donations are prone to breakdowns because a willing donor is not a compatible match, a recipient is too far away or a donor backs out of the extremely personal transaction.

Unver and his fellow researchers highlight a chain of kidney transplantations that started with a 28-year-old Michigan man in July of 2007 and led to 10 transplantations coordinated during 8 months by two large paired-donation registries, the 25-state Alliance for Paired Donation and Incompatible Kidney Transplantation Program at Johns Hopkins Hospital.

The transplantations took place at six medical centres in five states. Three kidneys from living donors were shipped – two using commercial flights – rather than requiring donors to travel to the recipient's hospital.

The computer models assign values to the characteristics of donors and recipients stored in massive databases. The programs then generate pairings based on with similar scores, imposing an order on these exchanges by overcoming issues that disrupt a market.

"Economists have been looking at solving the 'mechanism design' problem of paired donations by using data to increase efficiency," says Unver, whose early work on these models with fellow BC economist Tayfun Sonmez led to the founding of the New England Program for Kidney Exchange. "As work progressed, people began to see this was a way of overcoming the problems involved with paired donations."

Paired kidney donation surgeries are performed simultaneously to reduce the possibility of a donor backing out once a friend or relative has received a kidney.

A donation chain allows for greater flexibility, since not all surgeries must take place at the same time in the same hospital.

The researchers conclude further that kidney donor chains could shorten wait times on lists of unmatched patients in line for deceased-donor organs. The scope of the databases can pair these patients with suitable living donors, who account for approximately one-third of the 14,000 kidney transplantations that take place annually in the US.

(Source: Boston College: New England Journal of Medicine: March 2009)

“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