Researchers are reporting a high success rate for a novel kidney-swap program that proponents say could someday ease the nation’s shortage of transplant organs.
Most kidney transplants use organs taken from cadavers. But doctors prefer using organs from live donors, because the success rates are higher.
In a live-donor practice used increasingly in the U.S. over the past few years, a patient who needs a kidney is matched up with a compatible stranger; in return, the patient must line up a friend or relative willing to donate an organ to a stranger, too.
The practice is particularly useful in cases where a kidney patient’s friends or relatives are willing to donate an organ to their loved one but are not a suitable match.
In the first U.S. success-rate study of what are called “kidney paired donations,” Johns Hopkins University researchers tracked 22 patients who received kidneys from living strangers.
Of the 22 transplants, only one failed, because of clotting problems unrelated to organ rejection. That patient eventually received a kidney from a dead donor. Four patients also had treatable immune-system reactions. There were no deaths.
The patients were followed, on average, for 13 months, although two were followed only one month.
The success rates were comparable to other live-donor transplant rates, said study co-author Dr. Robert Montgomery, director of Johns Hopkins’ Comprehensive Transplant Center. The university’s kidney-swap program began in 2001.
The study appears in Wednesday’s Journal of the American Medical Association.
More than 63,000 U.S. patients now await a kidney transplant, according to the United Network for Organ Sharing. In 2004, 3,897 patients died while waiting for a kidney.
Though the kidney-swap idea has been around almost 20 years, only 64 U.S. patients have ever received a kidney transplant through a paired exchange, according to UNOS.
But “the momentum is increasing for a national program,” Montgomery said. At a conference in March, he and other specialists gathered in Chicago to develop a blueprint for a national paired organ exchange.
Proponents hope a nationwide system could help relieve the organ shortage and cut costs by getting people off dialysis.
Logistical and ethical problems
But such swaps involve logistical and ethical problems.
Dr. Lainie Ross of the University of Chicago, who with her colleagues wrote a 1997 paper laying out the ethical guidelines followed by Johns Hopkins, praised the research but said there are still unknowns, such as how the donor and recipient will fare emotionally.
“I could be glad some stranger gave me a kidney, but I don’t necessarily want to be his best friend,” she said. “And he may want to be my best friend because he wants to see how his kidney’s doing.”
At Johns Hopkins, donors must talk to a psychologist and a social worker to make sure they do not feel pressured to participate, Montgomery said. The operations studied were done simultaneously to prevent the ethical dilemma that could result if a donor wanted to back out of the trade.
Participants in the study did not know the identities of their donors until after the surgery. “They all elected to meet, except one person who wanted to just write a letter,” Montgomery said.
A 2004 Korean study also saw successful kidney transplants using the swap strategy.