July 22, 2009
A chain of small miracles started in Phoenix last week.
It began when a Michigan man decided to donate one of his kidneys to a person he had never met.
His decision means a Phoenix woman will be able to watch her grandchildren grow up. But it does not stop there. Now the Phoenix woman’s husband will donate one of his kidneys to a perfect stranger. That woman’s best friend will then do the same. And so on and so on.
Eventually eight people, and possibly far more, will be saved because of the marriage of good will and medical technology.
This kidney chain – the first of its kind – is possible because of a new type of organ donation called a paired donation.
It happens when someone who needs a kidney has a person who is willing to donate one, but their body chemistry prevents a good match.
In a paired donation, those two people will be connected with two other people in the same situation.
Each healthy person then donates a kidney to someone who needs it.
The only unusual thing is that the donors are helping strangers directly in order to indirectly help the person they love.
This type of approach, coupled with federal legislation awaiting President Bush’s signature, could ultimately transform the field of organ donation.
‘Paying it forward’
In Petoskey, Mich., Matt Jones made the decision to donate a kidney simply because he could.
In Phoenix, Barb Bunnell’s kidneys were failing, and she was learning that her husband would not be able to donate one of his kidneys to her.
It was Barb’s good fortune, however, to be a perfect match with Jones.
On Wednesday, his organ was removed at Banner Good Samaritan Medical Center in Phoenix.
Moments later, in the operating room next door, it was placed inside Bunnell. It is now keeping her healthy and alive.
“I will be able to live a longer life. And a better life,” Bunnell said from her hospital bed before her surgery. “I will not be on dialysis. I will watch my grandchildren grow up.”
It is the next step that will transform the one act into a series of life-changing events.
Barb’s husband, Ron Bunnell, will now donate one of his kidneys to a woman he’s never met.
“I look at it as Barb got this gift from Matt, and I’m just paying it forward,” Ron said. “It is terrific to be part of something bigger.”
The chain will not end there.
The woman receiving Ron’s kidney has a best friend.
That friend will donate one of her kidneys to another perfect stranger.
That kidney will begin a process where six other people will receive a new kidney under the same circumstance.
If everything works according to plan, the chain of donated organs started by Jones would continue.
“I thought that if I could help one person live a decent life, that would be great,” Jones said.
“It’s turned out to be a lot more than that.”
Paired donation cuts wait
The first successful living donation was in 1954 in Boston, when a brother gave his identical twin one of his kidneys.
Nearly always, a kidney is donated by sibling or dear friend or spouse.
That was the Bunnell’s plan.
The couple knew for decades that she would eventually face dialysis or need a transplant.
She has polycystic kidney disease, a hereditary disorder that killed her mother and grandmother in their mid-50s.
Ron Bunnell, the chief administrative officer at Banner Health, was eager to donate a kidney to his wife.
When Barb, 53, learned that her husband would not be a good match for her, she was devastated.
As her kidney function diminished – Barb’s were operating at about 18 percent of normal – she started looking into the field of paired donations.
A paired donation was her best chance.
Last week, there were 72,393 people waiting for a kidney in this country, according to the Organ Procurement and Transplantation Network, which works with U.S. Department of Health and Human Services.
Wait time can easily stretch to years depending on blood type and other variables.
But for paired donations, the wait is shorter, in part because while everybody on a paired donation list needs a kidney, everybody on the list also signs up with a person who has a kidney to give.
Barb Bunnell entered her data with the Alliance for Paired Donation in Toledo, Ohio, in May and a match was found almost immediately.
Paired donations first started occurring around 2000. Before Jones’ donation began the kidney chain, the practice usually involved just two pairs.
The benefits of paired donations extend beyond the possibility of a shorter wait.
The first is that in a paired donation, only living donors are used.
Most people who receive a kidney get one from a person who has died, though living donations now make up 45 percent of transplants.
Cadaver kidneys, though beneficial, do not last as long as a kidney from a live donor.
A kidney from a live donor is still working in 80 percent of recipients after five years. A kidney from a deceased donor is still working in about 55 percent of recipients after five years, according to the U.S. Department of Health and Human Services.
One reason for this is because a live donation can be planned.
In a cadaver donation, the donor may die at any time of day or night and perhaps hours away from the person who will receive it.
Despite the benefits of paired donations, ethical concerns were raised about the practice since it first began.
Some ethicists questioned whether the practice equated to “paying” for a kidney by offering one in return.
As more people have chosen this option – there have been 194 paired donations in this country – the medical community has come to support the concept.
It has earned the blessing of the Federal Organ Procurement and Transplantation Network, which governs transplants.
The Journal of the American Medical Association published an influential report strongly supporting paired donations in 2005.
The insurance industry also supports the practice. The cost of a transplant is high but can be significantly less than the cost of spending years on dialysis.
Now people in the industry are excited about the prospect of increased donations. When a person from a paired donation gets a kidney, it shortens the waiting period for others who need one without subtracting from the pool of organs.
Creating a chain
Paired donations can help the most people when a person like Matt Jones decides to give a kidney with no strings attached. When an altruistic donor enters the equation, it can set off a string of donations.
The beauty of paired donations is that with the addition of an altruistic organ, a chain like the one started last week can, at least in theory, continue forever.
Ron Bunnell will serve as the “bridge” donor when he flies to Toledo on Monday to prepare to donate his kidney to a woman named Angela. He described her as a 32-year-old who has been on dialysis for more than 10 years.”She has been so sick for so long, I don’t think she can remember what it is like to not be on dialysis,” Ron Bunnell said. “That’s why I am so looking forward to this.”
Dr. Michael Rees, medical director of the Alliance for Paired Donation, will perform the surgery on Thursday.
Rees, 44, has been instrumental in starting the alliance and in creating a computer program that can measure all the variables of a possible donation to make sure the right kidney ends up in the right person.
Rees finds that work rewarding, but an altruistic donor provides the chance for an endless number of sick people to get well.
“It’s hard to put into words,” Rees said. “The kidney that Angela’s partner is donating will allow six other people to get a new kidney. The line just keeps going.”
‘Doing the right thing’
None of that mattered to Jones, 28, when he decided to donate a kidney. He simply wanted to help one person.
Although people have questioned him relentlessly about his motivations, he always comes back to the same answer.
“In my opinion, it’s just like giving blood or donating to a charity. You’ve got something you don’t really need, you can help someone, you do it.”
Many of his friends in rural Michigan do not understand why he chose to put himself at risk – kidney donation is major surgery with a death rate of 3 per 10,000 surgeries – to help someone he did not know.
He has stopped trying to explain it to his brother. His fiancee, the mother of one of his four children, says she supported his decision even if it frightened her.
Jones said his decision to donate his kidney to a stranger was made easier, not harder, because he is a father.
“This is the right thing to do. It’s good for them to see their father doing the right thing,” Jones said. “And if one of my kids ever needed something like this, I hope somebody would do the same thing for them.”
Reach the reporter at john .firstname.lastname@example.org or (602) 444-4803.