Four lives saved in complicated kidney swap at UC Davis Medical Center
Shawn Klein recently received a new kidney – one of eight linked operations that gave kidneys to three others as well.
Alan Klein would have given anything to help his ailing younger brother. He tried to give a kidney. But despite their genetic bond, he wasn't a suitable donor.
But when an altruistic stranger arrived at the UC Davis Medical Center with a kidney to give, it set in motion a chain of linked donations that would ultimately save the lives of four Northern California residents over two days, including that of Klein's brother.
The eight operations – four pairs of surgeries to harvest a healthy donor's kidney and then transplant it into a patient – occurred over a 36-hour period on Feb. 22-23 and involved more than 30 UC Davis hospital staffers.
Members of the hospital's transplant team matched the donors and recipients by combing through a long list of patients waiting for kidney transplants. It was complicated work that involved using sophisticated computer algorithms and medical sleuthing to see who on the list could take part in the ambitious undertaking.
Klein's kidney went to another patient. His brother received someone else's kidney – he's not sure whose at this point.
The medical center in Sacramento has coordinated such donor swaps before, but nothing as elaborate.
"It was really quite an undertaking to make this happen," said Dr. Richard Perez, a surgeon and director of the medical center's transplant program. "It's a tour de force to have eight surgeries happen in 36 hours. They're big operations."
Similar domino transplants have been occurring more frequently across the country, some involving up to a dozen operations. In 2007, the New England Journal of Medicine reported on a chain of 10 kidney transplantations over eight months in five states – all triggered by a single altruistic donor.
Donor swapping would seem like common sense, but until now hasn't been done very often. Its use has grown in recent years with the help of sophisticated matchmaking software, said Laurie Reece, executive director of the Ohio-based Alliance for Paired Donation.
"It's very complicated (and) really difficult to facilitate," Reece said. "It takes a computer to analyze a bunch of scenarios."
In the past, those in need of a kidney mostly relied on family or friends. "When they were told, 'Sorry, you're the wrong blood type,' that was the end of it," Reece said. "Now there is an option."
More than 80,000 Americans needed kidney transplants in 2008, but only a fifth generally find a donor. Every day, about 12 people die while on the waiting list, according to the alliance.
Shawn Klein, 53, a registered nurse for the state of California, was running out of options when his kidneys took a turn for the worse last summer. He had been battling renal disease for 20 years.
Without a transplant, the Sacramento man would have had to continue dialysis treatments three times a week, with each visit lasting more than three hours.
Doctors told him he needed a new kidney. That's when his brother Alan stepped in to help – only to learn that he had a different blood type and therefore was incompatible.
Still, his willingness to donate his kidney meant his brother had a shot at getting a compatible one from someone else.
When a donor can't give an organ to their intended recipient, such as a relative or friend, because of a mismatch in tissue or blood types, doctors scour the transplant registry for a compatible patient who also has a willing, but incompatible, donor.
"If it wasn't for him, I wouldn't have gotten a kidney. I'd still be waiting on the list," said the younger Klein.
For Alan Klein, 60, it started with the urge to help his younger brother.
"I realized that I wasn't just helping my brother, but three other people," he said.
The surgeries took months to coordinate. So many things could have gone wrong. One of the patients could have gotten sick, delaying – or even scuttling – the entire operation.
There was also the risk of one of the donors pulling out – a very rare occurrence, said Perez, the UC Davis transplant surgeon.
"There's nothing new here scientifically. It's the willingness of people to donate, this concept of donor swapping, to give a kidney to someone you don't know in order to help your own loved one," Perez said.
"So many people need kidney transplants, but the pool of potential donors does not meet the need," he said. "Paired exchange has expanded the donor pool significantly and, in turn, is making many more transplants possible."
None of the transplant recipients know the identities of their donors, hospital officials said. They will find out later this month when they all meet for the first time.
Shawn Klein recently received a new kidney – one of eight linked operations that gave kidneys to three others as well.
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