A Transplant Triumph
A brave sister pair just advanced the case for living kidney donation

Sisters Annie, left, and CTC patient service coordinator Katie Bonner hope their experience will inspire others to donate organs.

Less than an hour later, Cooper, who is director of kidney transplantation for the Comprehensive Transplant Center, and surgical transplant fellow Dorry Segev have successfully exposed the external iliac vein and artery, which will ultimately connect the donor kidney. Then they wait.

In the next room, almost simultaneously, surgeon Keith Melancon is making four small incisions in the donor’s abdomen. The donor is Katie’s younger sister, Annie; the procedure, laparascopic. As Melancon (pronounced Mi-lan-SAN) probes with a fiber-optic instrument, a video monitor reveals the scene inside. Narrow tubes are inserted through the incisions, making room for Melancon to begin extracting the kidney. Everything’s going according to plan.

Katie, 28, knows what to expect. This is her third kidney transplant. But it is Annie’s surgical debut. She had become increasingly anxious as the big day neared. Now, though, she is asleep, unaware of the drama about to unfold.

Segev and anesthesiologist Chauncey Jones keep a close watch on Katie’s vital signs as Cooper hurries next door. Minutes later, he returns, cradling a cold blue basin in his arms. And there it is, afloat in saline: Annie’s healthy kidney, lavender and gray, shaped like the letter “C,” wrapped in gauze like a gift. “The extraction was nice and boring—just the way we like it,” quips Cooper.

Swiftly, Segev and Cooper bring together two arteries in the donor kidney and begin sewing to secure an opening for blood to flow into both vessels once the kidney’s implanted in Katie. Timing and temperature control are critical. Outside the body, the kidney must stay ice cold. Once attached, it must stay warm to thrive. One surgeon sews as the other holds the kidney in place.

Twenty-five minutes later, the payoff: Annie’s kidney—which had become a dull gray—has regained blood supply from Katie. Magically, the kidney glows bright pink. “Look, it’s making urine already,” Segev notes.

Surgeons Keith Melancon, left, and Matthew Cooper review the kidney transplant strategy just before surgery on the morning of March 14.

This April, as transplant advocates mark National Donate Life Month, Katie Bonner is living proof that transplants work. Living kidney transplantation shortens the recipient’s wait time and improves outcomes. For the donor, the laparascopic procedure to remove the kidney, pioneered at Hopkins, reduces recovery time because a large incision is unnecessary.

As a patient service coordinator in the Comprehensive Transplant Center, Katie has developed an intense empathy with patients. Each day, she spends hours on the phone and computer reminding post-transplant patients to keep appointments, take meds and maintain a healthy lifestyle. Katie wants to be a transplant nurse and is waiting to be accepted to nursing school. She plans to continue working part time at the CTC while in school. The best part of her job, she observed days before her March 14 surgery, is being on the “caring” end of transplantation, not the “sick” end.

Until she joined the CTC, Katie hadn’t recognized the huge responsibility transplantation requires from the team. Indeed, for living donations, six people assist in each OR. And 500 people, from database managers to surgeons, make up the CTC staff. “It’s humbling to see how hard everyone here works to ensure a transplant’s success,” she says.

Katie learned she had kidney disease at age 13, when she fell off her bike and broke her arm. A routine blood test revealed that inside her otherwise healthy body, her kidneys were failing. Katie’s father immediately offered to donate a kidney. But a week after his donation, the transplanted kidney failed.

Katie was placed on a transplant waiting list. Months later, pediatric surgeon Paul Colombani successfully implanted a cadaveric kidney (from a deceased donor) into her abdomen. It thrived for 15 years.

But now, Katie is engaged to be married and hopes to have children. Cooper told her pregnancy and delivery would be less risky if she had a kidney from a living donor. For one thing, fewer immunosuppressants, the antirejection drugs transplant patients take for life, are needed when the organ comes from a live donor. These medicines can have severe side effects when taken for long periods of time.

Another incentive for the surgery was that Katie’s cadaveric kidney was losing its efficacy. “Even though they’re pretty resilient,” Cooper says, “transplanted kidneys—especially cadaveric ones— weaken with time.” A pregnancy would tax the aging kidney, posing additional danger to Katie and the child.

The wedding date is set for June 3, 2006. Sixteen years ago on that day, Katie’s first transplanted kidney failed. “I wanted to turn a sad day into a happy one,” she said. For her father and sister—who gave up kidneys so she could live for milestones like these—the occasion will no doubt be especially joyful.

—Judith Minkove

A National Kidney Database Katie and Annie Bonner are biologically compatible, but in almost one out of three cases, people who want to donate kidneys to friends or family can’t do so because they have certain antibodies that would cause an organ to be rejected or because their blood and tissue types don’t match. Since 2001, the Incompatible Kidney Transplant Program, a division of the Comprehensive Transplant Center, has been offering several programs that surmount this problem and shorten wait time for kidneys. One is “paired kidney exchange,” a program that provides organs to patients who have a willing, designated donor who is biologically incompatible. A kidney from such a donor is matched to and transplanted into the recipient of a second donor-patient pair, and vice versa. The transplants are performed simultaneously. The CTC has done more paired kidney exchanges than any other transplant center in the nation. In March, the CTC organized a meeting with key people from transplant centers across the country. The goal was to create a national paired kidney exchange database. “This matching program will save thousands of lives each year and drastically reduce the medical costs associated with kidney disease,” said CTC director Robert Montgomery, expressing hope that the conference will be a major first step to alleviating the dire kidney shortage.