Surgeons at The Johns Hopkins Hospital have successfully completed their 100th kidney swap — a procedure popularized here to enlarge the pool of kidneys available for donation and provide organs to patients who might have died waiting for them.
The 100th kidney paired donation (KPD) was performed on Wendy Crowder, a 40-year-old Virginia woman on Dec. 15, 2009.
One form of kidney swap relies on a so-called "domino donor" effect, made possible by altruistic donors willing to donate a kidney to any needy person and other willing donors who are not a match for their loved ones.
The donors who are not a match agree to participate in a swap with other incompatible pairs. The friend or relative still donates — only to a stranger — and that stranger's loved one also donates a kidney in return. By exchanging kidneys between pairs, each sick person involved gets a compatible — and lifesaving — kidney.
"It is a very powerful thing for the people involved in these swaps," says Robert A. Montgomery, M.D., Ph.D., professor of surgery at Johns Hopkins University School of Medicine and director of Hopkins' Comprehensive Transplant Center. "They can sort of pay it forward, do something good not just for their loved one. They give a kidney to someone else and their loved one receives the gift of life in return. It is spectacular."
Crowder, from the Northern Neck of Virginia, was in pain from kidneys damaged by a lifetime of polycystic kidney disease. To quell the pain, both kidneys were removed and she was relying on dialysis three days a week to keep her alive, sapping the energy she needed to care for her 6-year-old son, Cody. Crowder's husband, Jeff, offered one of his kidneys, but his kidney was not a match.
Montgomery and his transplant team moved her into the paired donor pool and worked to find her a match by Christmas. On Dec. 15, she was transplanted, thanks to a domino donor chain that involved six people, three kidneys and hospitals in three states.
Jeff Crowder's kidney went to a 63-year-old man in Maine, while his wife got hers from a 60-year-old New Jersey man. Both Crowders said they were almost thankful that they did not match one another. That way, Jeff's donated kidney didn't just help her, but enabled two other people to get new kidneys as well.
Wendy was home by New Year's Eve and is feeling great, she reports. She is now well enough to do many of the things that pain and dialysis made impossible. Jeff, meanwhile, is back to work as an HVAC repairman. The couple went on a Valentine's Day date, their first dinner alone at a restaurant in nearly a year.
"I feel like a million bucks," she says.
Incompatible kidney matches are made by a complex computer algorithm developed at Johns Hopkins which links up compatible donors and recipients, almost like a computer dating service. Still, the computerized program has limitations. There is no national database of donors and recipients, only smaller regional or single-center clearinghouses of information. With a small pool, only a limited number of matches can be made. Montgomery says a national program could come up with 1,500 more live donor matches a year. In a move towards realizing this goal, the national Organ Procurement and Transplantation Network, operated under federal contract by United Network for Organ Sharing (UNOS), announced this month it will coordinate a pilot project to facilitate kidney swaps between the four leading kidney paired donation organizations, including Johns Hopkins.
Thousands die each year waiting for kidney transplants, Montgomery says, and with more people on transplant lists than ever before, transplant teams are turning more and more to live kidney donation. Kidneys from live donors tend to survive longer than those from deceased donors.
Johns Hopkins surgeons performed one of the first kidney paired donation transplants in the United States in 2001, the first three-way swap in 2003, the first five-way domino transplant in 2005, the first six-way domino transplant in 2007 and, in the summer of 2009, a multihospital, eight-way domino transplant — all matching incompatible donors with new recipients.
Montgomery calls the 100th kidney swap at Hopkins "a huge milestone" for the technique.
"The revolution that we've started in this way of getting transplants has spread throughout the country," he says. "We're very proud of that."
On the day of her transplant, Crowder remembers Montgomery holding her hands and asking her, "You ready to go to sleep and wake up with a new kidney?"
She was.
"I am indebted to my husband, Johns Hopkins and the gentleman who gave me my kidney," she says.
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