Sometimes making a difference through  giving starts not with the heart, or the wallet, but with… a kidney.

This summer, a 54-year-old on the East Coast offered to donate a kidney to anyone who needed it. This altruistic donor’s generosity resulted in a chain reaction that included 16 people and four hospitals across the country. Eight patients received living donor kidney transplants as a result of one person’s decision.

Surgical teams at Barnes-Jewish Hospital and The Johns Hopkins Hospital in Baltimore pioneered this multi-institutional transplant chain over a span of four weeks. The chain also included living donor transplants at Integris Baptist Hospital in Oklahoma City and Henry Ford Medical Center in Detroit.

The procedure, paired kidney exchange (PKE), pairs up willing kidney donors with compatible recipients in different locations and connects them.

MOTHER-DAUGHTER PAIR SAVES TWO LIVES

Mu Cha Leffler, 60, of Christopher, Ill., and her daughter, Christine Hargis, 36, were one of these pairs. Hargis was determined to get her mother a kidney transplant.  She enrolled in the Barnes-Jewish Hospital PKE?program and offered her kidney to any compatible recipient. In return, her mother received a kidney transplant at Barnes-Jewish Hospital in June. The kidney was procured from another living donor at Johns Hopkins and transported to Barnes-Jewish.

Two weeks later, at Barnes-Jewish, Hargis donated one of her kidneys to another patient waiting at Hopkins. “I didn’t care who received my kidney,” Hargis says. “I wanted to do whatever it took for my mom to get a kidney. It was the least I could do.”

The transplant chain was complete.

MORE PAIRS, MORE TRANSPLANTS

“What is unique about this chain transplant is that the donor and recipient pair can stay close to home for the transplant,” says Surendra Shenoy, MD, a Washington University kidney transplant surgeon at Barnes-Jewish. “It doesn’t matter where they live. We move the organs across the country rather than the patients.”

Dr. Shenoy says the idea for a multi-site, chain transplant with living kidney donors was born about four years ago as a way for more people to benefit from the living donor kidney transplant option. “It took a couple of years to get everything in place with coordination of data, legal issues and other factors. But now everything is in place to move forward with more multi-site chain transplants so they can happen more frequently.”

He says the kidney pairs list is growing at all four hospitals that are currently part of the program. He expects five other hospitals to join the program soon. “The idea is to have a large list of donor pairs. The more pairs, the more likely the matches, so the more transplants we’ll be able to do. We’ve already done them twice at Barnes-Jewish in 2009. The whole cycle starts with one altruistic donor.”

Currently the United Network for Organ Sharing is setting up a pilot program to develop a nationwide list of donor pairs. The collaborative efforts between Barnes-Jewish Hospital and Johns Hopkins are the model for this pilot program, which could result in an estimated 1,500 additional transplants each year.

Nearly 80,000 people in the U.S. – which include 1,300 in Missouri and 3,700 in Illinois – are waiting for a kidney transplant currently  and the list continues to grow. Yet less than 10,000 kidneys are available for transplant each year.

“One kidney donor actually helps two people,” Dr. Shenoy explains. “One person gets a kidney, so another  gets to move up the wait list for  transplant.”

LIVING DONOR TRANSPLANTS OFFER ADDITIONAL BENEFITS

Someone with kidney failure has two options: lifelong kidney dialysis or transplant. “A person who gets a transplant does better long-term compared to dialysis,” Dr. Shenoy says. “And someone who receives a kidney from a living donor transplant has better outcomes than someone receiving a deceased donor transplant.”

He says living with one kidney is perfectly suitable for a normal life and won’t alter a person’s lifestyle. “Some people are only born with one kidney and live long, healthy lives.”

For the person donating a kidney, Dr. Shenoy uses a minimally invasive technique that allows most patients to go home two days later. They can usually go back to work after two to three weeks.

A unique feature of Barnes-Jewish Hospital's transplant program is that team members follow patients for the life of their transplant for continuity of care. Patients also benefit from the support groups and the mentor program offered.

RESEARCH OFFERS BRIGHT FUTURE FOR TRANSPLANT

Dr. Shenoy has been performing kidney transplants since 1991. He, along with Martin Jendrisak, MD,  developed the mini-nephrectomy procedure that is now commonly used with many kidney donors across the country. “Transplant is a relatively young specialty, which is why it’s so exciting to be in it,” he says. “With the large living donor pool, the opportunities to save lives are huge.”

Dr. Shenoy says current transplant research focuses on methods to maximize the benefits of a transplant. “We want to increase not just the number of transplants, but the lifespan of a each transplanted organ. We continue to improve. In 1990, only 80 to 85 percent of kidneys transplanted worked after one year. Today, 96 percent of living donor transplants work for longer than a year.”

A PERSONAL CAMPAIGN TO INCREASE KIDNEY DONORS

Christine Hargis recognizes how many people could donate a kidney and save lives. She says the experience she and her mother had motivates her to want to crusade for kidney donation.

In September, Hargis and her parents appeared on “The Dr. Oz Show” with several of the people who were part of this summer’s 16-patient transplant chain. “I got to meet the woman who donated a kidney to my mother,” she says. “It was a wonderful, emotional experience.”

Hargis continues: “I hope more people will consider donating a kidney to a loved one or a stranger. I felt blessed with the opportunity to help my mother. You only need one kidney to live. If one in 100 people would be willing to donate a kidney, so many lives would be saved.”

Sidebar
Foundation-Funded Research Leads to Better Patient Response to Dialysis

In addition to kidney and transplant surgery, Surendra Shenoy, MD, with support from the Barnes-Jewish Hospital Foundation, is a leader in performing a procedure to help patients suffering from end-stage renal disease.

In this procedure, Dr. Shenoy creates an arteriovenous fistula (AVF), or connection between a vein and an artery, that allows better access to blood vessels for dialysis. This improves the patient’s response to dialysis, leading to better rates of survival with the least complications.

Dr. Shenoy uses ultrasound before, during and after AVF surgery to select the best surgical site and to evaluate the results. This innovative use of ultrasound has allowed him to increase the rate of patients receiving AVF procedures at Barnes-Jewish.

In 2008, the Foundation’s Transplant/Vascular Access Fund made it possible for Dr. Shenoy to purchase the next generation ultrasound machine developed specifically for vascular access so he can continue this critical aspect of his clinical work. “Treatment breakthroughs like the chain transplant actually result from years of painstaking research and clinical trials that test new uses of equipment or medication,” says Julia S. Ruvelson, Foundation vice president. “We hope our Transplant/Vascular Access Fund and the M. Ann Brown Liver Research Fund, both of which fund Dr. Shenoy’s projects, will lead to the breakthroughs of tomorrow.”

From Barnes-Jewish Hospital Foundation’s Giving Magazine, 2009, Issue 2