Video: Donation chain gives hope to transplant recipients

updated 8/4/2009 7:35:01 PM ET 2009-08-04T23:35:01

African Americans suffer disproportionately from kidney disease. And the scarcity of matching organ donors makes it more likely than an African American in need of a transplant won't get one.

More than 485,000 Americans are currently being treated for kidney failure, according to National Kidney Foundation. And of the roughly 85,000 people on the waiting list for a new kidney, 36 percent are African American—yet African Americans only receive about 15 percent of the living donor organs available.

According to Dr. Joseph Keith Melancon, M.D., director of the Kidney and Pancreas Transplantation Program at Georgetown University Hospital, the prevalence of risk factors for kidney disease in the African American community makes it extremely difficult for someone in need to find a donor who is willing and medically able to withstand the surgery who is a close enough match.

But there are some programs available to help pair donors and recipients whose blood types are otherwise incompatible: paired exchange and plasmapheresis. The National Kidney Foundation defines these programs as follows:

What is a paired exchange?

Sometimes a loved one may want to donate a kidney but their blood type is incompatible. Some transplant centers will help incompatible pairs of recipient/donors through a process called paired exchange, which involves two living donors and two recipients. If the recipient from one pair is compatible with the donor from the other pair, and vice versa— the transplant center may arrange for "swap"—for two simultaneous transplants to take place. This allows two transplant candidates to receive organs and two donors to give organs though the original recipient/donor pairs were unable to do so with each other.

Both donors and candidates are carefully evaluated and tested medically and psychologically to assure that the benefits outweigh the risks. It is important for both surgeries to be scheduled for the same time in case either donor changes their mind at the time of surgery. Surgeries can take place at the same or different hospitals. It can be advantageous if the surgeries take place at the same hospital though this may mean extra costs of travel and housing for one couple.

What is Plasmapheresis?

New protocols consisting of medications, spleen removal, and a form of blood filtering called plasmapheresis are allowing transplant candidates to receive kidneys from live donors with blood types that have traditionally been deemed incompatible.

Until now, a transplant patient could only receive an organ from someone with a compatible blood type. An organ from an incompatible blood type would be perceived as foreign and vulnerable to attack by the recipient's natural antibodies.Now, through a process of immune conditioning, a recipient is able to receive a kidney from a donor of a different blood type. This new procedure is currently being provided at a limited number of transplant centers.

The new protocol involves testing the proposed recipient to assess the risk of rejection from harmful antibodies. Next the recipient undergoes plasmapheresis, a process involving the removal of the plasma portion of the blood that contains harmful antibodies and the administration of a medication to prevent their production. The patient is then ready to undergo transplant surgery where, in addition to receiving a donor organ, the patient's spleen is removed using minimally invasive surgical techniques. In some cases, spleen removal can be avoided through the use of a new drug that creates similar effects.

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Post-transplant, the patient undergoes additional plasmapheresis treatments before being discharged from the hospital. He or she will then take the same immunosuppression medications as patients receiving a compatible kidney.

What is a donor chain, or "domino transplant"? 

A donor chain begins with one non-directed (altruistic) potential donor. In this program, the non-directed donor gives to a person waiting for a transplant, and that recipient’s willing—but incompatible—donor gives to another person waiting, and so on. Each living donor in this system gives to a stranger, and the chain of donors is kept going as long as possible.

For more information on new developments in kidney transplants, visit the National Kidney Foundation, or call 1-800-622-9010 for a free brochure: http://www.kidney.org

For more information about Dr. Melancon and incompatible kidney transplants, visit the Kidney and Pancreas Transplantation Program at Georgetown University Hospital:
http://www.georgetownuniversityhospital.org/body.cfm?id=556314

NBC's Kumasi Aaron contributed to this report.

Copyright 2009 National Kidney Foundation

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