Angel donors and angel flights in a NEPKE kidney exchange chain

One man's gift of a kidney brings hope to four people*: A NEPKE simultaneous chain, starting with a non-directed donor at Dartmouth.

My close colleague Jerry Green flew two of the kidneys in this exchange, first one from Lebanon, NH to Philadelphia, and then one from Philadelphia to Boston, as part of the Angel Flights program. (He's a private pilot, and his wife Pam accompanies him on these trips as his turbulence control officer...).

*Update: that link doesn't work anymore, but here's the story
One man's gift of a kidney brings hope to four people

By MELANIE PLENDA

Union Leader Correspondent

LEBANON -- A perfectly healthy man walked into Dartmouth Hitchcock Medical Center saying he wanted to help out, to give back to his community. So he offered his kidney. And because he did, four people were given a chance at a healthy new life.

"We have this happen periodically where people who really value their neighbors come in and want to help in very real ways," said David Axelrod, section chief of transplantation surgery at Dartmouth Hitchcock. "He's just a person who felt he wanted to give back. He said he wanted to give a kidney to whoever needed it most."

That one act of anonymous generosity sparked a simultaneous kidney swap chain among four people at four facilities in three states on Monday. Axelrod said the man requested his name not be released, but that he's a "healthy man who lives in northern New England."

Kidney swap chains have been in existence for several years, but are still relatively uncommon, Axelrod said. While four is not the most ever performed -- Johns Hopkins Hospital in Baltimore, Md., did a nine-person chain -- they are somewhat rare. And a four-pair swap had not been done at Dartmouth Hitchcock Medical Center, Axelrod said.

Typically the swaps start with one person willing to give a kidney to a loved one. If that kidney is not a match to the loved one, that person can be placed into a database of other willing, but incompatible donors.

"This option allows incompatible donors to help their loved ones to receive a living donor kidney by matching one incompatible donor/recipient pair with another incompatible pair," said Colleen Marshall, a Dartmouth Hitchcock spokesman in a news release. "In 'kidney swap chains' a number of willing donors exchange kidneys to recipients, thus increasing the number of life-saving surgeries being performed at the same time."

So, in the case of the mysterious man who offered his kidney to Dartmouth, his information was entered into The New England Paired Kidney Exchange -- NEPKE -- which maintains a registry of incompatible, but willing donor-recipient pairs. He turned out to be the missing biological puzzle piece for four people needing a kidney.

"The operations have to take place at the same time," Axelrod said. "Because you can't have someone in the chain decide at the last minute they don't want to do it."

So at precisely 7:30 a.m. Monday donors went into surgery in Lebanon; Our Lady of Lourdes Medical Center, Camden, N.J.; St. Barnabas Medical Center, Livingston, N.J.; and Beth Israel Deaconess Medical Center, Boston.

By 9:30 a.m. the organs had been harvested and were winging their way to their waiting recipients, who were outfitted with their new kidneys and stitched up by about 12:30 p.m., Axelrod said.

"We are very pleased with how everything turned out," Axelrod said.

So far, all the donors and recipients were doing well and recovering, he said. The original mystery donor was only in the hospital for a day and half before he was well enough to go home.

"There are between 60,000 and 80,000 people waiting for a kidney," Axelrod said. "These databases and people like this man are the fastest and best way to get living donor kidneys to people who really need them."


And here is the Dartmouth news release:

D-H participates in successful "Four-Pair Kidney Swap Chain"

April 29, 2010
Lebanon, NH --

On Monday, April 26, the Dartmouth-Hitchcock Medical Center Transplant Center participated in a successful "four-way kidney swap chain" involving donor/recipient pairs at four different transplant centers. The DHMC surgery was managed by David Axelrod, MD, Section Chief, Transplantation Surgery.

All four-donor surgeries were performed simultaneously at the participating transplant centers: Dartmouth-Hitchcock Medical Center; Our Lady of Lourdes Medical Center, Camden, NJ; Saint Barnabas Medical Center, Livingston, NJ; Beth Israel Deaconess Medical Center, Boston. Once the organs were harvested they were flown by separate planes to the waiting recipients who received their new kidneys later in the day. 

"Paired kidney exchange" offers new life-saving options to those seeking a kidney transplant, but whose potential living donor is not a good biological match due to either blood type or cross-match incompatibility. This option allows incompatible donors to help their loved ones to receive a living donor kidney by matching one incompatible donor/recipient pair with another incompatible pair.  In "kidney swap chains" a number of willing donors exchange kidneys to recipients, thus increasing the number of life-saving surgeries being performed at the same time. Living-donor kidney transplants have better outcomes, less rejection and are longer-lasting, making them preferable to deceased-donor transplants.

The New England Paired Kidney Exchange (NEPKE), which maintains a registry of incompatible, but willing donor-recipient pairs, coordinated the multiple pair exchange in conjunction the transplant coordinators at the participating hospitals.

DHMC's transplant program began just over 15 years ago. Since then, hundreds of kidneys have been transplanted in both adults and children with a success rate that exceeds the national average. In 2006, the solid organ transplant program expanded to include pancreas transplants, and has quickly become one of the leading pancreas transplantation centers in New England.

For the past five years, DHMC has achieved a greater than 75 percent conversion rate on potential organ donations. This puts DHMC in an elite group of less than 2 percent of hospitals nationally that have repeatedly achieved this level of success. Some of these organs go on to be used in transplant surgeries at DHMC, and others are distributed nationally based on need.

Recently, DHMC was recognized for the fifth straight year by with the Organ Donation Medal of Honor by the U.S. Department of Health and Human Services (DHHS) for its sustained efforts in achieving high organ donation rates. DHMC also was recently named an Anthem Blue Cross Center of Medical Excellence for Medical Transplantation, a program that recognizes hospitals that have historically demonstrated quality clinical care and processes in transplants. DHMC was re-designated by Cigna as a transplant center of excellence.

Visit the DHMC Transplant Center website for more information.

For more information contact Colleen Marshall at (603) 653-1909.