Transplant project to spur kidney swaps

WASHINGTON - Too often, would-be kidney donors are wasted because the friend or loved one they want to help isn't a match. Now a new national database promises to help find matches for those frustrated pairs so they can be part of so-called kidney exchanges and cut the wait for a transplant.

If the long-awaited pilot project by the United Network for Organ Sharing pans out, specialists predict it eventually could result in an extra 2,000 to 3,000 transplants a year through "kidney paired donation," where someone donates a kidney on a patient's behalf so that patient can receive a compatible organ from someone else in return.

"The more people involved, the more people match," explains Dorry Segev at Johns Hopkins University Hospital, which pioneered kidney swaps and is one of four transplant-coordinating centers helping to run the UNOS project.

Kidney paired donation is increasing but still rare - with more than 760 performed in the last three years - and patients today often must track down participating centers and travel hundreds of miles for surgery.

"I do have friends that are on dialysis that can't afford to come this far to receive a transplant," says Heather Hall, 31, of Denham Springs, La., who was one of 16 patients to receive a new kidney during an unusually large exchange last week at Georgetown University Hospital in Washington.

Born with bad kidneys and needing her third transplant, she read about Georgetown's program after doctors in Louisiana said she had become too hard to match. Her aunt donated on her behalf.

The UNOS project, which began last month, is part of a broader effort to increase kidney paired donation, considered one of the best bets at boosting live-donor transplants - the optimal kind. Some transplant centers already have formed regional alliances to mix and match larger numbers of patients and their would-be donors. Even some small hospitals are making a name for themselves by amassing lists of potential swappers."We're trying to tell folks, 'Don't take no for an answer,' " says transplant surgeon Adam Bingaman of San Antonio's Methodist Specialty and Transplant Hospital, who led a 16-way kidney exchange this month.

Of the more than 87,000 people on the years-long national waiting list for a kidney, at least 6,000 could qualify for a kidney swap if only they knew about that option, Bingaman recently wrote in the New England Journal of Medicine.

Fewer than 17,000 kidney transplants are performed in the United States each year, and just over a third are from living donors, relatives, or friends who happen to be biologically compatible.

Without their own donor, patients await a cadaver kidney - and nearly one in three patients may never get one because their immune system has become abnormally primed to attack a new organ, says Georgetown kidney-transplant director Keith Melancon. Black patients are most at risk, but anyone can become "sensitized" from pregnancy, blood transfusions, dialysis, or, like Hall in Louisiana, a previous transplant.

Kidney paired donation evolved as an alternative for people with incompatible donors, especially those extremely hard-to-match.

Source: Philly.com Health News , By Lauran Neergaard "Associated Press"