First NY–to–LA living-donor transplant chain results in triple kidney transplant
The lives of three Los Angeles-area kidney transplant patients were transformed by one of the West Coast's first three-way living-donor kidney transplant chains, made possible through the generosity of a non-directed, altruistic kidney donor from New York City, it was announced today at a joint news conference.
The carefully orchestrated surgeries, which took place July 24 and 30 at NewYork-Presbyterian Hospital/Weill Cornell Medical Center and Ronald Reagan UCLA Medical Center, also involved one of the first transcontinental live-kidney donations.
The kidney from the New York donor was delivered by the New York Organ Donor Network to UCLA's operating room for the July 30 transplant after being removed by Dr. Joseph Del Pizzo, director of laparoscopic and minimally invasive surgery in urology and associate professor of urology at NewYork-Presbyterian/Weill Cornell.
The "donor chain" is an innovative twist on efforts aimed at increasing thedonor pool by giving people who are unable to donate to a loved one or friend the opportunity to still give a kidney through an exchange between incompatible donor-recipient pairs. The domino effect of "chains" creates recipient-donor "clusters," with each subsequent cluster beginning with a "leftover" donor who starts the new cluster. (For a graphic illustration of the donor chain, see www.uclahealth.org/images/news/TransplantIllustration-2.jpg.)
NewYork-Presbyterian/Weill Cornell and its medical partner, The Rogosin Institute, initiated one of the nation's first three-way kidney donor chains in February. The UCLA chain is the first in Southern California, bringing hope to those with kidney disease in California and the western United States. The project partners with the National Kidney Registry (www.kidneyregistry.org), which matches donors and recipients through a specialized computer program developed by businessman and registry founder Garet Hil.
Hil started the registry when his youngest daughter needed a transplant and tests revealed that her body would have rejected his kidney, as well as kidneys from three uncles and the anonymous New York donor who ultimately started the chain at UCLA.
"If all incompatible donors and recipients were simply listed in one common pool, the problems related to incompatible and poorly matched donors and recipients would be a thing of the past," Hil said.
NewYork-Presbyterian/Weill Cornell introduced the registry to UCLA a few months ago, prompting UCLA to join the innovative program, said Dr. Jeffrey Veale, assistant professor of urology at the David Geffen School of Medicine at UCLA and director of the paired-donation program.
"This is a rare instance of a living-donor kidney being shipped across the country to initiate a chain," Veale said. "If we can become comfortable shipping living-donor kidneys like we do with deceased-donor kidneys, then thousands of patients will have the opportunity to receive a kidney who otherwise would have been forced to remain on dialysis."
Dr. Sandip Kapur, chief of transplant surgery and associate professor of surgery at NewYork-Presbyterian/Weill Cornell, said, "The hope is that this marks the first of many such collaborations among the nation's transplant centers. Donor chains have enormous potential to expand the donor pool and to provide better matched organs for the many individuals who are in desperate need of lifesaving transplants."
Dr. David Serur, medical director of The Rogosin Institute Transplant Center and associate professor of clinical medicine at NewYork-Presbyterian/Weill Cornell, said that kidney donor chains could have a significant impact on the country's organ donor shortage.
"Most paired exchanges are swaps, and they end, whereas the chain involves an extra donor in the beginning, so you can initiate a self-propagating cascade," " Serur said.
Normally, a kidney is delivered when it comes from a deceased donor; live donors typically have the kidney extracted at the same center where it is implanted in the recipient the same day.
"But in this case, UCLA received a live-donor kidney from New York, which hasn't been done before," Veale said.
The Kidney Chain
From left to right--Pamela Heckathorn, David Busk,
Here's how the kidney chain worked at UCLA.
Pamela Heckathorn, of Cypress, Calif., was to receive a kidney from her cousin Dave Busk, who lives in the Los Angeles area; husband and wife Arturo and Maricela Carvajal, of Fillmore, Calif., were to have formed a donor-recipient pair; and Randy Platt, of Covina, Calif., wanted to give a kidney to his mother, Inocenta. But each of these donors turned out to be incompatible with their loved ones.
So on July 24, Busk's kidney was given to Maricela, and Arturo's was given to Inocenta. And on July 30, the altruistic New York donor's kidney was flown from NewYork-Presbyterian Hospital/Weill Cornell to UCLA and given to Pamela Heckathorn. Meanwhile, Randy Platt will be the "bridge" to initiate another cluster and more transplants.
"Living-donor exchange represents the pinnacle of teamwork and professional and personal trust and good faith that ideally epitomizes the organ transplant endeavor," said Dr. Gabriel Danovitch, professor of medicine in the UCLA Division of Nephrology and medical director of the UCLA Kidney and Pancreas Transplantation Program. "The team consists of surgeons, physicians, nurses, coordinators, patients and donors all working together toward the same goal."
Other members of the UCLA surgical team were Dr. H. Albin Gritsch, associate professor of urology and surgical director of the UCLA Kidney and Pancreas Transplantation Program; Dr. Gerald Lipshutz, assistant professor of surgery and urology and director of the UCLA Highly Sensitized Kidney Transplant Program; Dr. Peter Schulam, associate professor of urology; and Dr. Jennifer Singer, assistant clinical professor of urology at the David Geffen School of Medicine and director of pediatric urology at Harbor-UCLA Medical Center. Dr. Alan H. Wilkinson, director with Danovitch of the Kidney and Kidney-Pancreas Transplantation Programs and professor of medicine, Division of Nephrology and Suzanne McGuire, R.N., living-donor transplant coordinator, were also involved with the patients' care.
Other members of the NewYork-Presbyterian/Weill Cornell transplant team included Dr. David Leeser, assistant attending surgeon and assistant professor of surgery in transplantation; Marian Charlton, R.N., living-donor transplant coordinator; Judith Hambleton, R.N., director of living-donor transplantation; Allyson Pifko, R.N., transplant data coordinator; and Jennifer Keen, L.M.S.W., living-donor transplant social worker.
Nearly 79,000 people are on the kidney transplant waiting list in the United States, according to statistics from the United Network for Organ Sharing. California alone has some 16,240 people on the list.
"Patients can wait up to eight years for a deceased-donor transplant," Veale said. "This donor chain may enable hundreds of patients to receive a kidney, thanks to one generous altruistic donor, rather than in the past, where only one patient benefited from an altruistic donor. This could significantly decrease the waiting list for kidney transplantation."
Background on Donors and Recipients
The altruistic donor's decision to give a kidney was the culmination of several profound life experiences.
"I have had the incredibly sad experience of having a colleague die while waiting for a kidney transplant," said the donor, who chose to remain anonymous. "I have a close friend who donated a kidney to her brother, and I have a close friend who received a kidney more than a decade ago - and I see the terrific experiences she's had since.
"When I started thinking about it, I thought, I'm able and healthy at this point in my life to do this - to help someone have more years of a better life - why not donate? The beauty of this partnership between excellent doctors, transplant coordinators and staff at NewYork-Presbyterian/Weill Cornell, UCLA and a group of seven people - a partnership connecting both coasts - is that a chain of people have better lives, and the chain goes on."
Pamela Heckathorn, 51, has polycystic kidney disease (PKD). Her father died of complications from PKD at age 49, and her brother, who also has PKD, received a transplant about 10 years ago.
"If we can get this exchange program going, it's going to be the answer to lots of people's situations," she said. "This is going to help so many people down the line."
For his part, David Busk, a detective with the Los Angeles County Sheriff's Department, is happy that the program is keeping Heckathorn off the grueling dialysis regimen.
"I really believe this program is a good thing," said Busk, who is only seven days younger than his cousin. "Pam couldn't sit on the transplant wait-list for several years - something needed to be done. I'm glad I could do my part to help."
For Maricela Carvajal, 36, who was discovered to have kidney problems when she was pregnant with her daughter 13 years ago, her participation may serve to highlight the importance of organ donation among Hispanics, who are generally reluctant to be donors.
"To me, it's unfortunate that more Latinos don't donate," she said. "Everyone would benefit if more donated. Today it's me, tomorrow it's someone else."
Her husband, Arturo, said this system gives life to others and will also free his family to visit relatives in Mexico. They can't go now due to Maricela's dialysis schedule.
"Whatever affects her impacts everyone in the family," the 44-year-old Arturo said. "It was like a closed door that is now being opened again."
Inocenta Platt's kidneys were destroyed by the auto-immune disease lupus. Though her son Randy wanted to donate, the 52-year-old Inocenta's body would have rejected his kidney without large amounts of anti-rejection medications, since the match was not ideal. The decision to be involved was an easy one for mother and son.
"Randy and I talked about it, and we said, 'OK, he's willing to give to somebody else, and I won't have to take as many medications after the surgery,'" she said.
Randy, 30, feels proud in his position as the bridge donor to a new cluster.
"It gives me a sense of purpose," he said.
He was determined to participate, even losing weight in order to qualify for the surgery.
The UCLA Kidney and Pancreas Transplantation Program performed its first kidney transplant in 1957 and for the past 50 years has continued to be a national leader in both clinical research and academic excellence. UCLA is the second-largest kidney transplant program in the country and the largest in Southern California, performing hundreds of adult and pediatric transplants each year. The program has some of the best outcomes in the country, according to the Scientific Registry of Transplant Recipients, a national database of organ transplant statistics. UCLA's program has helped pioneer the use of minimally invasive laparoscopic surgery to remove kidneys from living donors. For more information, visit www2.healthcare.ucla.edu/transplant/kidneyhome.html.
NewYork-Presbyterian Hospital's organ transplantation program - which includes NewYork-Presbyterian Hospital/Weill Cornell, NewYork-Presbyterian Hospital/Columbia and the Rogosin Institute - has performed more transplants this year than any other center in the nation. It offers comprehensive and personalized care for the heart, liver, pancreas, kidney and lung. With outcomes ranked among the nation's best, the hospital is dedicated to improving quality of life for its patients. NewYork-Presbyterian's dedicated teams of surgeons and physicians are responsible for many significant advances made over the past several decades in transplant surgery and the maintenance of healthy organs. The hospital has been on the forefront of developing and improving anti-rejection medications (immunosuppressants), minimally invasive surgery for living donors, genetic methods to detect transplant rejection, strategies to increase opportunities for donor matching, islet cell transplantation and the Food and Drug Administration-approved left ventricle assist device (LVAD), which functions as a bridge to transplantation for those waiting for a new heart.