Kidney Paired Donations - a Better Way to Save More Lives

One option is to have your name added to a waiting list for a kidney from someone who has just died. It's a good idea, especially since automation now makes it easy to track information about each patient. But that list has 70,000 names on it, and the average waiting period is about five years. Almost half the people on the list either will not live to receive a donation or will become too ill to survive the transplant surgery.

There is another option. If your donor is willing to give their kidney to someone else, you might be able to receive a kidney from someone who is compatible with you.

That's the premise behind kidney paired donations. The simplest scenario involves two donor-recipient pairs who "trade" donations - the donor in one pair gives to the recipient in the other pair, and vice versa. A more complicated setup involves one donor giving to a recipient whose donor gives to another recipient, whose donor gives to another recipient, and on down the line. It creates a "domino effect," and in fact is called a domino transplant.

Of course, in this case it's likely that one recipient will be left out. That's where "altruistic donors" come in. An altruistic donor is a person who's willing to donate, but doesn't have a recipient already chosen. That donor's kidney could go to the "mismatched" recipient - the person without another compatible donor.

The benefits of shared organ donations were demonstrated recently by the first ever quintuple kidney transplant, when five recipients received five kidneys - from people they'd never met - in a marathon surgical procedure at The Johns Hopkins Hospital.

It started with four pairs of incompatible donors and recipients. Each donor was willing to donate to someone else; it just happened that three of the donors turned out to be compatible with three of the recipients. But that left one donor with no one to give to. It was a simple process to find a compatible recipient from the waiting list, but unfortunately, there was still one recipient without a donor.

That's when the altruistic donor stepped in. Her kidney was compatible with the one person in the group who didn't have a donor. Since everyone involved was already there, and waiting would have risked canceling all the surgeries (if someone had become too ill to have the surgery), the doctors decided to go ahead and operate on everyone right away. The five donation operations were done simultaneously in the morning, and the five transplants were done in the afternoon. They all went well.

This is an extreme example of kidney paired and domino transplants, but it illustrates how effective they can be. In fact, the head of the incompatible transplant program at Johns Hopkins did a computer model that estimated that paired donations could almost double the number of kidney transplants done in a year. Increasing the number of transplants would reduce the size of the waiting list, shorten the waiting time, and increase the number of lives that could be saved.

There's another reason to increase paired donations - they use living donors. Not all transplants "take," but transplants from living donors have the best chance of success.

You may be wondering why this hasn't been attempted on a larger scale before. There are a couple of reasons. The biggest is probably an ethical issue related to the National Organ Transplant Act of 1984, which forbids exchanging anything of value for an organ. It was probably intended to stop the buying and selling of organs. But the term "anything of value" could also mean another organ. There are efforts being made to amend this law or enact other legislation that would make the law more open to organ "swaps."

The other reason is a shortage of willing altruistic donors. It's possible people don't know that donors and recipients need to be compatible; in other words, not everyone can donate to someone they love, even if it's a blood relative. Or maybe people don't realize it's possible to donate an organ even when they don't know anyone who needs one.

Some people may also have issues with donating something as precious as an organ to a complete stranger. That's something that physicians and programs like the ones at Johns Hopkins are working to change. The recent quintuple transplant not only made medical history; it also made the news, bringing the problems - and possibilities - of organ transplants into the public eye.

To return to the opening example: What if your chosen donor couldn't give you their kidney, but was willing to give to someone else? If there was a compatible donor for you, would you agree to an exchange? Would you be willing to receive a kidney from someone you didn't know - if it saved your life?

And, on the flip side - Would you be willing to give a kidney to someone you didn't know?

Different people may have different answers to these questions. But the recent experience at Johns Hopkins has at least shown what the cooperation of donors and recipients can accomplish.