Expanded Kidney Transplant Opportunity

By M. Jill McMaster

The first successful kidney transplant was performed in 1954 at the Peter Bent Brigham Hospital in Boston. Richard and Ronald Herrick were identical twins, but Richard was dying of kidney disease. Ronald donated one of his kidneys, and it was successfully transplanted into Richard.

This taught medicine a great deal by proving the earlier investigations of the British researcher Peter Medawar. His work had showed that the body's rejection of foreign tissue was an immune response. In 1960 Medawar and his colleague Sir Frank Macfarlane Burnet, received the Nobel Prize for this discovery.

In 1960, Peter Medawar introduced a way of typing tissue, just as blood typing had been discovered in 1900. By 1962, tissue typing and immune suppression with drugs was used for the first time in a human kidney transplant. Between 1954 and 1973, about 10,000 kidney transplants were performed.

A highly effective immunosuppressant, cyclosporine, generally introduced in the 1980s, was a breakthrough in preventing rejection and opened a new era in transplant surgery. In 1986 alone, for example, nearly 9,000 kidney transplants were performed in the United States.

Since then, thousands of people have benefited from kidney transplants.

Rotary International actively promotes organ donation.  In the US, the formal “Share Your Life-Give of Yourself” program has been in place for ten years.  You have received information about these programs at zone institutes, district and multidistrict conferences, and presidents-elect training seminars.  While these efforts have surely helped, the need for organs continues to grow.

There is an exciting new opportunity for kidney transplant candidates in the United States. 

We have all heard it before from our friends and colleagues on the kidney transplant waiting list, maybe you’ve even said it yourself, “My (husband, wife, child, cousin, friend) volunteered to give me a kidney, but we were not compatible.” 

That statement soon will be relegated to the history books. Living donor paired kidney exchanges can make it happen.

According to the United Network for Organ Sharing (UNOS) on its Transplant Living website, “A paired exchange donation consists of two kidney donor/recipient pairs whose blood types are not compatible. The two recipients trade donors so that each recipient can receive a kidney with a compatible blood type. Once the evaluations of all donors and recipients are completed, the two kidney transplant operations are scheduled to occur simultaneously.” 

In other words, if Donor A is not compatible with Recipient A, and Donor B is not compatible with Recipient B, then Donor A can be matched with Recipient B and Donor B can be matched with Recipient A.

This practice of matching pairs has been successfully tested in a small number of transplant centers and has been shown to work well.  More people are being transplanted with good kidneys in a timely manner. 

New legislation and a U.S. Department of Justice opinion in April of this year, have paved the way for the development of a national network in the future to facilitate living donor paired kidney exchanges.  In the meantime, with legal issues resolved, additional transplant centers will likely begin these exchanges and even cooperate with centers in their regions for additional opportunities for matches.  It is clear that the larger the pool of donor/recipient pairs, the greater the opportunity for matches. 

Everyone wins with living donor paired kidney exchanges:

-More transplant candidates receive organs,

-Recipients are removed from the waiting list for deceased donors thus benefiting those who continue to wait,

-Research indicates that an organ from a living donor is preferable to that from a deceased donor,

-Medicare saves money as more people with end-stage renal disease are transplanted instead of remaining on dialysis, and

- The living donor has the satisfaction of giving the gift of life.

Individuals interested in living donor paired kidney exchanges should consult with their transplant teams.  The website Transplant Living website will continue to report on the progress of a national system.

Currently there are 72,000 people in the United States waiting for a kidney transplant.  Imagine if a significant portion of those people had a willing donor, blood type compatible or not.  For the first time we could actually see the waiting list shrink.  Wouldn’t that be a wonderful development?