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Physicians Update

 
Spring 2013

Kidney-Transplant Chains Help to Keep Patients and Hope Alive

UCLA Kidney Exchange Program Demand for donor kidneys is far greater than the supply, and some patients must wait as long as a decade for a suitable donor. While a loved one or friend may be motivated to donate, about one-third of the time they are unable to do so because they are not immunologically compatible.

But an innovative program that exchanges the kidney from an incompatible family or friend for a compatible kidney from a stranger is giving UCLA patients hope of being freed from the constraints of dialysis. “It’s a winning situation for everyone,” says Jeffrey Veale, MD, assistant professor of urology and director of the UCLA Kidney Exchange Program. “Instead of waiting years for a deceased-donor kidney, patients can quickly receive a living-donor kidney — which in general lasts twice as long. Additionally, once these patients receive their living-donor kidney they are removed from the deceased-donor waiting list, reducing the competition for cadaveric organs.”

“However, none of this would be possible without the generosity of altruistic donors to trigger the chains,” says Dr. Veale. “There are no obvious benefits for altruistic donors, and they are putting themselves at risk for a total stranger. I don’t think our society has adequately recognized the heroism of altruistic donors.”

A transplant chain begins when an altruistic donor gives his or her kidney to a recipient who already has a willing donor but that donor’s organ is incompatible. That recipient’s willing but incompatible donor then passes on the generosity to a different recipient, whose willing but incompatible donor does the same, keeping the chain alive. A specialized computer program run by the National Kidney Registry matches donors and recipients across the country.

The UCLA Exchange Program began in 2007 and at first used a simpler exchange formula. At that time, there were two parent/child pairs with reciprocal blood types. Each child wanted to donate a kidney to his or her individual parent but had an incompatible blood type with their own parent. Dr. Veale simply swapped the kidneys by having each child donate to the other child’s parent.

UCLA has one of the world’s highest-volume kidney-transplantation programs and is the most active chain-transplantation center in the United States, performing 90 chain transplantations to date. “Besides getting people transplanted rapidly with the highest-quality organs, there’s a real humanity component to this program,” says Dr. Veale. “It’s beautiful to see people giving and receiving kidneys from complete strangers. The recipient usually doesn’t meet the donor until after the transplantation, and I feel extremely fortunate to often be the one who gets to make that initial introduction.”

Dr. Veale was senior author on a recent article that reported the results of 272 chain transplantations (the largest study to date). Approximately 50 percent of the chain recipients were female and 46 percent were ethnic minorities — two groups that have historically had a difficult time finding matches due to their naturally elevated antibody levels.

Dr. Veale is in the process of reporting UCLA’s experience in transplanting living-donor kidneys that have been shipped from the East Coast after being on ice for 10-to-18 hours. “As transplant chains have gained popularity, a donor that could unlock a recipient at our center often lives on the East Coast. Rather than having the donor fly to Los Angeles, the kidney is shipped. Initially there was concern that placing living-donor kidneys on ice for prolonged periods of time would affect their function. However, this doesn’t seem to be the case. In fact, the living-donor kidneys appear to function just as well if they are removed in the operating room next door or in New York,” Dr. Veale says.

One of the factors driving the growth of chains is that donor surgery now is being performed laparoscopically. In the past, donating a kidney meant being hospitalized for up to a week; most of today’s donors leave the hospital the next day. Similarly, the amount of time donors would miss work in the past was two to three months, now it is typically only four to six weeks. With shorter recovery times for kidney donors, the relationship to the recipient has become more elastic. Originally, it was just family members who were able to donate, but over the years it has become acceptable for spouses, friends and now complete strangers to donate a kidney for transplantation.

In 2011, a chain intertwined the lives of 60 strangers and involved the donation of 30 kidneys across the country; UCLA handled 16 of the patients, the largest number of any participating hospital. “The chain-transplantation program is truly remarkable, as it enables us to take the gift from a single altruistic donor and amplify it dozens of times,” Dr. Veale says.

How a kidney chain transplantation works

For more information and to watch a video about the UCLA Kidney Exchange Program, go to: transplants.ucla.edu/kidneyexchange





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