'Donor chain' makes organs available to more patients

Five patients from Minnesota and North Dakota have new kidneys after participating in a "transplant chain" organized by three hospitals.

Kidney transplant chains are still rather rare occurrences, but they are happening more often as hospitals expand and share their living donor pools.

The sequence of 10 surgeries that resulted in five new kidney transplants was started by an anonymous donor in the Twin Cities. The donor's identity can't be revealed as a condition of participating in the program.

Even transplant surgeon Eric Finger doesn't know much about the person. Finger works at the University of Minnesota Medical Center, Fairview -- one of three hospitals that organized the transplant chain.

Finger says the donor put no restrictions on who should get the kidney, and that set in motion the possibility of putting together a chain of transplants.

"They primed a sequence of donor and recipient pairings, where each recipient in turn had their donor donate to the next person in the chain, allowing us to perform five kidney transplants," Finger explained.

The recipients and their donors were drawn from a pool called a paired donor exchange. Patients who sign up for the pool bring with them willing kidney donors, who can't be matched to them because of incompatible blood types or other factors. The donors agree to donate their kidney to someone else, but only if their recipient will get a new kidney in exchange.

Donor exchange registries haven't been around that long, so some registries are still pretty small. But as they grow, Dr. Finger says matches are becoming much more likely.

"Just now we're getting enough patients listed in these various registries to start to be able to do these paired donor exchange chains," he said. "While we've been discussing the possibility over the last months to years, it's really been recently it's become a reality."

This is the first time the U of M has participated in a kidney transplant chain. But in the past few years, these types of chain surgeries have happened frequently at other hospitals around the U.S. Some chains have included 20 or more recipients and donors.

Despite all of the attention that transplant chains have attracted, they are not how most kidney patients in the U.S. get new organs. The vast majority either find their own donor, or they wait for years before a kidney may become available from a deceased donor.

Nearly 11,000 kidney transplants came from deceased donors last year. There are currently 85,000 people on the national waiting list for a kidney from a deceased donor.

It's not likely that the pool of deceased donor organs will increase by much in the years ahead. And it's also not likely that the demand for those organs will decline. So the live donation program represents the best hope for expanding the pool of available kidneys.

There are other medical reasons to encourage living donor donations, according to Dr. Mark Odland, a transplant surgeon at Abbott Northwestern Hospital in Minneapolis -- another hospital that participated in the recent kidney transplant chain.

Odland says kidney recipients who get organs from living donors tend to do much better after their transplant.

"With the live donation the quality of the kidneys are so much better," said Odland. "The transplants work so much better, and the people don't need to spend that time on dialysis."

It may not be long before the pool of living kidney donors is bigger and much easier to match.

This fall, the Organ Procurement and Transplantation Network will launch a pilot program that will merge donor registries from multiple states, in hopes of maximizing the number of live donor kidney matches.

"If we can get a national program together, the initial estimates would be potentially an additional 1000 to 2000 extra kidney transplants a year in this country," said Dr. John Friedewald, a kidney specialist who works with the network. "[It] would not alleviate the entire need, but would certainly be a good step in the right direction."

The pilot program involves medical centers in California, Ohio, Maryland and New England.

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