Mix, Match, and Switch
Kidney exchanges between strangers are helping to ease the organ shortage and could save thousands of lives
BALTIMORE-Chantal Adamson is bouncing up and down on her bed with excitement. That's hard, since she's tethered to an IV. Plus the small patient bed in her room at Johns Hopkins Hospital isn't exactly a trampoline. But Adamson, a 29-year-old with kidney failure slowly dying on dialysis, can't sit still just before 7 o'clock this September morning. "Oh, I can't wait. I've been sick for so long, for three years," says Adamson, who lives in Deland, Fla. "And now I'm finally going to get a kidney."
Tammy Williams, resting in another bed one floor away, is a lot calmer. That's no real surprise, for the 40-year-old from Petoskey, Mich., isn't sick and isn't waiting for an organ. She's the donor. "Donating is such an easy thing to do," says Williams. "It's just a 3-inch incision." Williams had seen a letter from Adamson's mother pleading for a donor to save her daughter's life on a website called Matchingdonors.com. "It really touched me," says Williams. "It's like seeing someone in a burning building-you want to rush in and help them." Months of phone calls and E-mails between the two, sharing details of their lives and their hopes, cemented the relationship, the decision to travel to Hopkins for treatment, and Williams's determination to donate.
But Williams isn't giving her kidney to Adamson. She's giving it to Melanie Balhatchet, a 35-year-old from Spanish Fort, Ala., with a degenerative kidney disease who also depends on a dialysis machine for survival. Williams doesn't know Balhatchet's name or almost anything else about her. What she does know is that she and Adamson are a bad match: Adamson will reject her kidney. And she knows that if she gives her kidney to this woman she's never met, the woman's husband-a bad donor for his wife-will give his healthy kidney to Adamson, who matches up well with it. "Lock and load, let's go," Williams says, sinking back on her pillow.
Kidney swaps like this, called paired exchanges, are a new and growing trend. Instead of waiting years on the United Network for Organ Sharing list for a compatible kidney-as 67,962 people currently are-someone with kidney failure and a willing but incompatible donor can ask a hospital to find them a pair in similar straits, and the hospital can mix and match. (Liver swaps have been done in South Korea but not yet in the United States.) There have been 109 such swaps since Rhode Island Hospital in Providence did the first one in 2000. "It's a great concept," says surgeon Mark Aeder, director of kidney transplants at University Hospitals-Case Medical Center in Cleveland, which has done 12 swaps. "You don't want your patients sitting on a transplant list. You want to help them," says Aeder. "And they do better with a transplant than on dialysis." Plus, live kidneys simply work better than kidneys donated by dead people. The failure rate for kidneys from cadavers, five years after a transplant, is about 30 percent. But that rate drops to about 16 percent for live transplants. Swaps can increase the number of live transplants sixfold for people with hard-to-match blood or tissue types, according to a study published last year in the Journal of the American Medical Association.
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