McGowan Institute for Regenerative Medicine faculty member Ron Shapiro, MD, is director of the kidney, pancreas, and islet transplant program at the UPMC Thomas E. Starzl Transplantation Institute and professor of surgery and Robert J. Corry Chair in Transplantation Surgery at the University of Pittsburgh School of Medicine. On December 10, Dr. Shapiro and a team of UPMC doctors participated in UPMC’s first kidney paired donation in collaboration with Temple University Hospital and the Paired Donation Network. The couples, a husband and wife from Pittsburgh and two sisters from Philadelphia, donated kidneys to each others’ loved ones in a two-way surgical swap. Such paired exchanges are still uncommon. All donors and recipients are recovering well.
The Pittsburgh recipient, Galina Komar, and her husband, Vyacheslav Komar, the original intended donor, were not ABO compatible. Instead, Mr. Komar traveled to Temple and donated his kidney to Mimi Weber of Philadelphia. The exchange then enabled Ms. Weber’s sister, Wendy, who could not donate to her sister because of incompatible blood types, to donate her kidney to Mrs. Komar at UPMC Montefiore.
The independent matches between the Komar and Weber families were identified after each couple had been through the preliminary screening processes at UPMC and Temple. This exchange was facilitated by the Center for Organ Recovery and Education (CORE) and the Gift of Life through their affiliation with the national donor registry.
The Paired Donation Network, administered locally by CORE, allows individuals to give of themselves to benefit another person through living donation. Though their intended donor is medically eligible to become a live donor, they have immunological or ABO incompatibilities with the recipient. This program offers patients with end-stage renal failure the hope of finding a compatible living donor. By agreeing to exchange recipients—giving the kidney to an unknown, but compatible individual—the donors provide two patients with healthy kidneys where previously no living donor transplant would have been possible. Through the registry, recipient and donor pairs are matched, thus creating two harmonious pairs.
“With the advancement of surgical technology, live donors who have laparoscopic surgeries compared to traditional open nephrectomies have a very low incidence of complications and recover quicker,” said Henkie Tan, M.D., Ph.D., F.A.C.S., director of the Living Donor Kidney Transplant Program and the UPMC Thomas E. Starzl Transplantation Institute and associate professor of surgery at the University of Pittsburgh School of Medicine.
Dr. Tan, who was involved in the first living donor paired exchange kidney transplants at Johns Hopkins in 2001, performed Ms. Weber’s donor surgery at UPMC. While at UPMC, he has pioneered and developed the laparoscopic live donor nephrectomy program in which about 80 operations are performed on a yearly basis. “One hundred percent of our laparoscopic donor procedures have resulted in usable kidneys,” noted Dr. Tan.
Even in the midst of the national organ-donor shortage, Dr. Tan states, “the Paired Donation Network offers advantages to a significant number of patients awaiting transplantation with their innovative and systematic approach to matching pairs, resulting in more life-saving kidney transplants and better outcomes.”
“Paired exchange represents an opportunity to perform renal transplantation in two or more patients in a situation where it is otherwise not possible or straightforward,” said Dr. Shapiro, who led the team for Mrs. Komar’s recipient surgery.
“Living donor kidneys on average last twice as long as deceased donor kidneys, and are generally associated with better function and less rejection,” Dr. Shapiro added.
Today, paired donation transplants are organized through a national paired donation program. The Paired Donation Network, of which Dr. Shapiro serves as president, has facilitated over 36 kidney transplants between incompatible donor/recipient pairs, and has enrolled over 200 incompatible donor/recipient pairs from over 80 kidney transplant programs, including UPMC, all currently awaiting appropriate matches.
“This was a happy and exciting opportunity,” said Dr. Shapiro. The couples agreed to the exchange and this transformed a situation where no transplant could be performed into one where two successful transplants became possible; it became a win-win for everyone.”
“CORE is excited to be part of this first paired kidney donation in the CORE service area,” said Susan Stuart, president and CEO of CORE. “We look forward to the altruistic and paired kidney donation program to increase the hope for a transplant for many. Across the nation, there are thousands of people living with the hope for a kidney transplant and the paired donation program gives them the opportunity for a matched kidney that might otherwise not occur. The generosity and foresight of the individuals participating in the paired kidney donation program is beyond measure.”