April 21, 2006
BIRMINGHAM, AL — Thanks to a new UAB program, a Georgia man and a Bessemer, Alabama, woman who both expected to wait many years for kidney transplants received new organs on Wednesday. They were the first patients to receive a paired kidney exchange that matches a patient who has a willing, healthy living donor — sister and fiancé, respectively, in this case — with another donor and recipient, forming two compatible pairs.
UAB transplant doctors hope the Living Incompatible Kidney (LINK) transplant program will reduce long waiting times and help ease the organ shortage. Transplant surgeon Alan M. Hawxby, M.D., recruited from The [cq] Johns Hopkins Hospital to start the program, said, “As many as a third of patients are incompatible with their potential living donors. With the new paired kidney exchanges through LINK, a donor freely offers a kidney to a stranger in order to get their own loved one transplanted by another donor with a reciprocal situation.”
Hawxby said Alabama is the 23rd most populous state, but ranks fifth in the number of patients with kidney failure. “That leads to a large number of people who are on renal dialysis, which is not conducive to high quality of life, with repeated hospitalizations and frequent infections. Many of these dialysis patients are on our transplant waiting list, which is why that list now numbers more than 2,400, with waiting times for transplants of typically four-to-five years and sometimes more.”
He said several more paired kidney exchanges are being evaluated. He expressed gratitude to the many UAB units and staff who worked diligently over the past several months to make the program a success.
Such operations have been performed in the United States since 2001, but none that he’s heard of in the Deep South. Hawxby participated in several exchanges while training at Hopkins, including two that involved three pairs. A recent Hopkins analysis reported high success rates for patients undergoing kidney swaps, finding that outcomes were comparable to traditional live-donor transplants.
All patients in the first such UAB procedure are recovering well and are listed in Good condition, Hawxby said. The two pairs are:
Recipient James Thorn Jr., 38, of Bainbridge, Georgia, and his sister, Cynthia Rayburn, 42, of Jefferson County; and recipient Dwana Lewis, 29, and her fiancé, Alex Caldwell, 40, both of Bessemer. In the exchange, Rayburn donated to Lewis and Caldwell donated to Thorn.
A surgical team is required for each of the four surgeries. Leading the donor surgery teams were transplant surgeon Michael J. Hanaway, M.D., and urological surgeon Donald A. Urban, M.D., who operated on Caldwell and Rayburn, respectively. Both donor kidneys were removed using hand-assisted laparoscopy, a minimally invasive procedure that allows those patients to be discharged from the hospital within a few days of surgery.
Leading the recipients’ surgeries were Hawxby and Mark H. Deierhoi, M.D., for Thorn’s operation, and Devin Eckhoff, M.D., and Harry Sun, M.D., for Lewis’s surgery. These patients may be discharged in the next several days while their immune-suppressing medications are being adjusted.
Both pairs of patients initially are kept anonymous from each other. When admitted to the hospital, they are assigned to different nursing units, go to different pre- and post-operative areas and return to separate nursing units afterwards. Their families wait in different areas, also.
To prevent any possibility that one of the donors might back out of the operation at the last moment, all the patients are simultaneously put under anesthesia.
Matching the appropriate incompatible pairs is a complex undertaking that requires additional staff and operating rooms, and a carefully choreographed operating room process, according to Eckhoff, who is director of the UAB Division of Transplantation. “The UAB Transplant Program has committed considerable resources for this program because of its great potential to provide relief to many of our patients,” Eckhoff said.
National Kidney Foundation President David G. Warnock, who is director of the UAB Division of Nephrology, noted: “This development marks an important milestone in the ongoing growth of the UAB transplant program. It will broaden the choices of patients with chronic kidney disease who are needing living donors for transplantation.”
Nationally, including at UAB, the number of donated kidneys coming from living donors has increased dramatically in the last decade, as kidney-failure patients realize that the number donors available through organ banks is not rising by much. Family members and other loved ones may want to volunteer to donate one of their kidneys, but frequently are turned down for medical reasons. Others are told they cannot donate to their relative or friend because they have tissue characteristics that are incompatible or because the patient’s blood contains proteins that would cause the kidney to be rejected.
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