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Hand-me-down kidney transplanted twice in two weeks

A single kidney that was transplanted twice in two weeks is working fine after what appears to be the first-ever case of doctors salvaging a hand-me-down organ after it started to fail.

Erwin Gomez, a 67-year-old Chicago-area surgeon and father of five, is the third and, hopefully, final owner of the kidney, which was transplanted last June 16 -- and again on June 30 -- at Northwestern Memorial Hospital in Chicago.

It originally came from Cera Fearing, a 21-year-old day care worker from Elk Grove, Ill., who donated the organ in hopes of helping her big brother.

“The whole point of giving it was to give him a new life,” she said.

Instead, Ray Fearing, 27, of Arlington Heights, learned within days of receiving Cera’s kidney that the organ was failing, attacked by a reoccurence of his longtime disorder, focal segmental glomerulosclerosis, or FSGS, a common kidney disease in which scar tissue develops on the part of the kidney that filters waste from the blood.

Dr. Lorenzo Gallon, the transplant expert who treated Fearing, said he just couldn't stand to let a good organ go to waste, especially in a nation where nearly 92,000 people are waiting for a kidney transplant.

"This kind of like haunted me," said Gallon, who is medical director of the hospital's kidney transplant program and associate professor of medicine and surgery at the Northwestern University Feinberg School of Medicine. "I thought, I just gotta do something so at least something good can come out of this."

Gallon had warned Fearing that there was perhaps a 50-50 chance that the kidney could fail because transplantation doesn't always stop FSGS. In addition, a reoccurence of the disease could threaten Fearing's life. When Gallon saw signs that it was happening, he consulted with his colleagues and with the hospital ethics board to discuss reusing the kidney in another patient.

"The kidney ... was still a relatively healthy, viable organ that could be transplanted into someone else without FSGS," said Gallon, whose feat is chronicled in a letter in the latest issue of the New England Journal of Medicine.

At first, the news was disappointing for both Ray Fearing and his sister.  

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“When I found out it was going to be taken out of my brother, I was a little upset,” Cera Fearing said. “I figured it was going to go into the trash.”

Doctors offered Ray Fearing three options: Keep the new organ and hope for the best, remove the kidney and discard it, or donate it to someone else.

For Fearing, who was diagnosed with FSGS at age 15 and had spent 10 years hoping for a kidney, the choice was obvious.

“Why would I just throw out a kidney?” he said. “I know exactly what it’s like to want it so bad.”

That’s where Dr. Erwin Gomez came in. He’d been on the kidney transplant waiting list for about four months, after diabetes and poorly controlled high blood pressure left him on the verge of kidney failure.

“Initially, I was hesitant,” said Gomez, who worried about the condition of an organ that had already been transplanted once.

But when doctors told him the FSGS now affecting the transplanted kidney was reversible, and he would ultimately wind up with a healthy organ from a living, 21-year-old donor -- all without the typical five-year wait -- he decided to go ahead. Within days, the new kidney was functioning normally.

“I consider myself very blessed, with a well-matched kidney,” Gomez said.

Fellow kidney transplant specialists consider Erwin blessed as well. Dr. Matthew Cooper, director of the kidney transplant program at the University of Maryland, had never heard of a failing kidney being removed from an FSGS patient and re-implanted in another person.

“It’s pretty amazing stuff,” said Cooper, who chairs the National Kidney Foundation's "End the Wait Committee." “It’s very difficult once that kidney is transplanted to think about re-transplanting it.”

The trio that shared the kidney -- Cera Fearing, Ray Fearing and Gomez -- met for the first time Wednesday in an emotional encounter at the hospital.

Ray Fearing is now back on dialysis, with possible plans to seek another kidney transplant in a couple of years. He says he’s doing fine, and has recently discovered that he can travel and obtain dialysis in different locations across the country. 

Gallon, who expressed affection and admiration for Fearing and his family, says it may be possible for the young man to have another transplant in the future, and there's a chance that the organ will function properly. For other patients awaiting kidney transplants, he says the success of the secondhand implant could well spur new research into FSGS and new thinking about what to do when an organ fails.

"Instead of tossing them out, you'll reuse them," he said. "It opens the window to using organs that we would throw away." 

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