U.S. News Sits In as Surgeons Carry Out an 8-Person Kidney Exchange

 kathmandu:november 11/25/2017 saturday; Birbal Tamang.

 CHICAGO = Today, Kevin Condreva will receive a new kidney at Northwestern Memorial Hospital. All told, his transplant will involve surgery on eight people.

Condreva, 22, and his aunt, Donna Spans, 63, are two links in a transplant "chain" that by the end of the day tomorrow will give a new lease on life to four people from the Chicago area. Condreva is actually undergoing his second transplant; he was just 15 when he first noticed blood in his urine and was diagnosed with IgA nephropathy, a common kidney disease that damages the organ's ability to filter waste from the blood. When he was 17, his mom was his donor, but the disease came back. That kidney failed, too.
Spans, who is not a match for her nephew, undergoes surgery here as well – ready to trade one of her kidneys to a stranger so that Condreva can receive one from another stranger and be freed from nightly dialysis. She and the other members of the group won't know who donates to whom as they head into surgery, but Spans' kidney will go to Patricia Tripolitakis, 51, who has polycystic kidney disease. Her husband, Leo, 51, is donating to Lee Jenkins, 53, whose wife, Lorretta, 46, is giving a kidney to Steven Boone, 46. Condreva's donor, a good Samaritan who prefers to remain anonymous, turned up as a match for him just a few weeks earlier and set the chain in motion. Later, Maggie Swanson, a friend of Boone's who wanted to help him but wasn't a match, will donate a kidney to someone else in need – potentially starting a new chain.

Such "paired exchanges," first performed in the U.S. at Rhode Island Hospital in 2000, have taken off in the last seven years or so as a way to shorten what can otherwise be a long wait for a healthy kidney. Some 97,000 people are now on the waiting list maintained by the United Network for Organ Sharing, a nonprofit that manages the federal organ transplant system; the average wait time is generally about three to five years. That's too long for many people: About 12 die each day as they hope for a kidney to turn up. A swap like this one effectively fast-tracks the process. At Northwestern, the period between joining the exchange program and surgery typically varies from about two to six months depending on the difficulty of matching.

Today, 20 to 30 percent of living donor kidney transplants here are done through the paired exchange program, mostly in four- to eight-person swaps. Each week, clinicians run a computer program to explore potential matches from among the incompatible pairs in the system. "There are actually multiple potential solutions that we can look through," says John Friedewald, a transplant nephrologist and medical director of the kidney transplant program. Northwestern also participates in the UNOS kidney paired donation program, which includes roughly 250 paired donors and candidates across the country. The National Kidney Registry, another nonprofit organization, facilitates hundreds of exchanges a year nationwide. In 2015, the NKR organized the longest swap to date, a 70-person chain involving teams at 26 hospitals.

By about 7:30 a.m. on the morning of the surgery, Condreva's donor and Spans are in separate operating rooms. Surgeons use a minimally invasive approach, making a series of incisions about the size of a centimeter through which they insert instruments and a tiny camera to guide their work; the kidneys are extracted through a slightly larger cut. The minimally invasive technique has "made the idea of donating a less scary undertaking" because it's safer than open surgery and recovery is much more rapid, says Joseph Leventhal, who directs the kidney and pancreas transplant programs and is performing several of this week's procedures.

By late morning, Condreva and Patricia Tripolitakis are sedated and in the OR. Their surgeons make a long incision across their lower abdomens and patch each new kidney into its blood supply and the ureter, the tube that moves urine from the kidney to the bladder. Before long, the transplanted organs are working fine. Later that day, Condreva and Tripolitakis are up and moving gingerly around the hospital floor.

A match depends largely on blood type and the presence of antibodies, proteins in a recipient's immune system that guard against foreign viruses and bacteria and can cause the system to reject a kidney even from a donor whose blood type matches. Such was the case for Condreva and Spans, who both have Type A blood and initially were a match. They became incompatible because Condreva developed resistance to his aunt – likely a result of several blood transfusions and the transplant from his mom, Patricia, who is Spans' sister.

After Condreva's doctors at Northwestern determined that his aunt could not be his donor, "that forced the issue of swap," says Spans, who was eager to help her nephew by way of giving to another recipient. ("I think God wants more than one person to get a kidney," she reflected the night before surgery.) Condreva "was very hard to find a match for, so this was sort of a needle in the haystack," Friedewald says. But early this summer, when the altruistic donor approached Northwestern and was determined to be an answer for Condreva, that kidney was the first domino that allowed the other matches to be made. U.S. News visited Northwestern Memorial in late June to attend the surgeries – and the celebration days later when the donors and recipients met.
 
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