Chain of hope: 5 kidneys donated

One anonymous Minnesota donor launched a series of five kidney transplants last week, the first time such a complex chain of surgeries has originated among the region's hospitals.

The 10 surgeries at three hospitals in Minnesota and North Dakota resulted from a new practice of pooling donors and recipients in a way that can exponentially increase the number of transplants, bringing hope to hundreds of thousands of people who need new kidneys.

Such highly choreographed exchanges have occurred at transplant centers elsewhere, but until now only simple, two-way trades have occurred here, transplant officials said. They expect that the coordinated transplants will become increasingly common.

"We are starting to roll," said Dr. Ty Dunn, the transplant surgeon at the University of Minnesota Medical Center who led the effort to get the chain launched.

The 10 surgeries started Tuesday of last week and concluded on Monday. Two were at Sanford Health Medical Center in Fargo, four at Abbott Northwestern Hospital and four at University of Minnesota Medical Center, Fairview, both in Minneapolis. The hospitals declined to identify the patients, citing ethics and privacy policies.

The exchanges, in which kidney patients swap donors in order to get compatible kidneys, are the latest development to increase the number of transplants for the hundreds of thousands of people nationally who need new kidneys.

Most people who need a kidney have someone willing to donate, but often those donors don't match the recipient's blood or tissue type. As a result, more than 80,000 people are now on the national kidney waiting list. Many of them will die before they can get a kidney from a deceased donor. Many more people are in kidney failure, and survive thanks to dialysis.

Minnesota's kidney transplant centers have been developing a pool of paired donors and recipients since 2007, but the number of registered pairs was not large enough to make chain transplants work, said Eugenia Steffens, the transplant coordinator at Hennepin County Medical Center who manages the program.

In January, there were only 19 pairs in the pool who came from 10 kidney transplant centers in the Midwest. That's when HCMC participated in a successful two-way swap with a pair from a pool managed by Johns Hopkins University in Baltimore.

Since then, Steffens said, the number of pairs in the pool doubled to 40 as both surgeons and patients heard about it.

"Enrollment really went up in the last few months," she said.

'Paying it forward'

But other transplant centers have used altruistic donors to start a chain of donation, a classic example of "paying it forward," that sharply increases the number of possible transplants. That's what happened in this case, Steffens said. Instead of two matches, five were made among donors and recipients in the pool.

By happenstance, the kidney from the last donor went to the extraordinarily lucky patient who was highest on the University hospital's transplant list.

"It's a wonderful thing," said Frances Hoffman, director of transplant services at Abbott.

"We need to do more of this."

Dunn said that the University transplant center now has changed its approach to patients and donors. When a patient brings in a donor who turns out not to be compatible, the center volunteers another option.