Almost two years after the world's longest chain of kidney transplants started with an altruistic donor from Michigan, a story about the locally coordinated approach to generate more and better matches is appearing today in the New England Journal of Medicine.
Dr. Michael Rees, a transplant surgeon at the University of Toledo Medical Center, the former Medical College of Ohio, is the medical director of Maumee-based Alliance for Paired Donation Inc. He said the article should give critical exposure to the alliance's method aimed at increasing life-saving kidney transplants.
The alliance's method is based on an altruistic donor who voluntarily gives a kidney to anyone in need, starting a chain reaction among recipients with willing but incompatible donors who in turn donate to another person.
The article explains how a chain of 10 kidney transplants has worked without all of the donor and recipient surgeries needing to be done at the same time.
Transplants typically are conducted simultaneously in limited numbers for fear a donor will back out, but the alliance has coordinated 19 transplants in six chains without any such problems, Dr. Rees said.
"All chains are ongoing, and nobody has yet reneged," said Dr. Rees, who started working on the "never-ending altruistic donor" method in 2000 and is the article's lead author.
He added about donors reneging: "I'm much less concerned about that than I was when I started."
So far, more than 1,200 people have registered on the alliance's Web site, www.paireddonation.org, with more than 250 being potential altruistic donors, Dr. Rees said. He created the alliance to help people with willing donors who are not matches by lining them up with other recipients and donors, either in paired exchanges or through a chain started by an altruistic donor.
Dr. Kenneth Andreoni, vice chairman of the United Network for Organ Sharing's kidney transplantation committee, called the alliance's 10-transplant achievement "fantastic."
The network is developing a national kidney paired donation system. The favored method remains straight exchanges, where one incompatible pair is matched with another so both recipients have a suitable donor, said Dr. Andreoni, an Ohio State University Medical Center surgeon.
The key is to get more incompatible pairs registered in the system to diminish the need for lengthy chains that require more organizational work and could break, he said.
"Every time you add another pair in the mix, it gets a lot harder," he said.
Yet the alliance's chain approach may help increase the number of transplants performed and improve the quality of matches, according to the New England Journal of Medicine article. If a chain is broken by a donor who fails to donate, it would not cause irreparable harm to the intended recipient, who still would have a willing donor with whom to enter another exchange, it states.
Professionals at Carnegie Mellon University, Boston College, University of Cincinnati, and Harvard University helped make the alliance's chain approach possible by developing computer models and software identifying the best possible matches, the alliance said.
Matt Jones of Petoskey, Mich., started the alliance's first altruistic chain in July, 2007, by donating a kidney to an Arizona woman. The father of five has told The Blade he long has been a blood donor and became interested in kidney donation after seeing a television program.
The second recipient in the chain, Angela Heckman of Toledo, received a kidney from the Arizona woman's husband soon after. And her mother, Laurie Sarvo of Toledo, donated a kidney seven weeks later to a recipient in Columbus, the third in the continuing chain that has had an 11th donor ready for almost a year.
The alliance's second chain, started by altruistic donor Tracy Armstrong of Maumee, has resulted in five kidney transplants so far. Four other chains have started, Dr. Rees said.
Still, only about 10 percent of altruistic donors registered with the alliance have been evaluated, a process that costs $3,000 to $5,000, Dr. Rees said. "We just don't have the resources," he said.
More than $1 million has been donated to the alliance from UT Medical Center, the Life Connection of Ohio, and other sources, Dr. Rees said.
Today's medical journal article, however, may generate more government and philanthropic funding for the nonprofit alliance, he said.
Letting more people who need kidney transplants know about the alliance's work is his primary goal, Dr. Rees said. The alliance is working with more than 70 transplant programs in 25 states.
"I hope the word gets out to people with kidney failure so they will register on our Web site and we can help them," Dr. Rees said.