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Kidney donors and recipients meet for the first time |
Hopkins transplant surgeons made international headlines in late July 2003 by performing the first known three-way, paired kidney swap that linked incompatible donor and recipient pairs. In the procedure each pair receives a kidney and each one gives one up to another two people in the choreography of the swap.
In six of the hospital’s operating rooms and with some three dozen surgeons and ancillary medical staff, Robert Montgomery, M.D., Ph.D., led the simultaneous surgeries that were completed within 12 hours. Logistics and timing had to be planned with precision and with hope that no medical surprises would occur during the procedures.
A few days after surgery, donors and recipients met each other for the first time and participated in a press conference at Hopkins.
The surgery brought six strangers together and they will be forever linked, physically, and emotionally. The pairs were: Connie Dick and Tracy Stahl, sisters from Pennsylvania; Paul Boissiere and Germaine Allum, an engaged couple from Florida and Trinidad; and Jeremy Weiser-Warschoff and Julia Tower, friends from Maryland.
Approximatey four months after surgery, recipients and donors are doing well and have had time to reflect upon the experience.
Tracy Stahl, her new kidney working just fine, says, “I am leading a normal life now,” and is relieved that her dialysis is history. Julia Stahl, whose kidney went to Tracy, was back at work within a short time after the surgery. “It is a life-changing event to be able to have the opportunity to do something like this, to give someone back their existence,” she reflects.
Dr. Montgomery points out that the number of live donor transplants will increase in the future because of the organ shortage. “The most promising hope of closing the gap between organ supply and demand is through live kidney and liver donation,” he noted.
The gift from a live donor actually benefits two people: the recipient of that organ and a person who does not have the option of a live donor and receives the deceased donor organ that is freed up as a result of that gift.
Triple Swap Heroines
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There are unsung heroines in the story of the triple swap.
Margery Pozefsky, a stranger to the triple swap participants, is the first heroine. She has made all Hopkins kidney swaps possible since 2000, when she herself received a kidney. After her son, Payton, donated a kidney to her, she and her husband, Thomas Pozefsky, M.D., an internist on the faculty at Hopkins, wanted to make a gift so that the matching process would be easier for others than it was for her and her family.
For each of the past three years the funding has supported the paired kidney matching effort. Her funding covers the salary of the nurse “matchmaker,” and ancillary costs of database development. Her support has contributed significantly to the growth and stability of the Paired Kidney Exchange Program.
On the medical side of the triple swap, unsung heroines, transplant coordinators Janet Hiller, R.N., B.S.N., and Jennie Rickard, R.N., B. S. N., as well as tissue typing specialist Julie Graziani, B.S., worked the computers and also searched patient records manually to make the six matches.
Says Ms. Hiller who found the matches, “It’s about half and half, computer and hand searching for the connections. The process is difficult and complicated. So many prospective donors did not match from the entire pool we manage.”
She added, “Many of our Paired Kidney Exchange patients come from outside our area, and they offer new combinations of antigens we can work with to try to make a match.” Over a period of several months she and others scoured the records. As the final donor, Julia Tower, entered the system here, the matches were made.
The Hopkins Advantage
The transplant team at Hopkins has pioneered several innovations that now make it possible for most patients with renal failure to receive a kidney from any donor, regardless of his or her blood type.
In the Paired Kidney Exchange Transplant Program, two donor/recipient pairs whose blood types are not compatible can exchange kidneys. One incompatible donor/recipient couple (or pair) gives a kidney to another donor/recipient pair and they receive a kidney from the first couple.
Hopkins was the first hospital in the country to offer this option and at the end of 2003 had completed five double exchanges, as well as the triple swap in July, for a total of 6 exchanges.
The path to a transplant was long for all participants until the matches were made at Johns Hopkins. Each pair had attempted to be transplanted at other centers but was unsuccessful.
Germaine Allum, a recipient, had been working with a transplant center in Florida before a friend told her about the Hopkins Incompatible Kidney Program. She and her fiancée donor, Paul Boissiere, decided to explore the option here. When she arrived in Baltimore to meet with the team she was very ill, wheelchair-bound. Medical personnel feared she might not make it to transplant.
Recipient Tracy Stahl and her donor sister Connie Dick had attempted to be paired with others at a Pennsylvania transplant center for some time when family members suggested they look into the Incompatible Kidney Program at Hopkins. A web search and research convinced the two women to come to Baltimore as a final effort.
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Janet Hiller looks on as special “donor |
“We knew about paired donations from the beginning,” said Linda Warschoff, one of Jeremy Weiser-Warschoff’s parents. Elsewhere, she said, “there are no resources and infrastructure to do the matchmaking. If Johns Hopkins hadn’t had a program in place, no one would have done it, even a two-way swap.”
Says Dr. Montgomery, “The Johns Hopkins Comprehensive Transplant Center continues to pioneer new approaches that will enable more of our patients to receive state-of-the-art care and a chance at a better life.”
Hopkins Milestones
• Live donor liver program begins, 1992
• First laparoscopic live donor nephrectomy in the world, 1995
• First reported altruistic donor operation in the world, 1999
• The Incompatible Kidney Transplant Program becomes the first
program in the world dedicated to transplanting patients with
donor/recipient incompatibilities, 1998
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The swap needed 3 of |
• First paired kidney exchange in the U.S., 2000
• First triple swap in the U.S., 2003
Bridges Winter 2003-2004
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