Kidney Chain That Includes 7 Patients And Four Medical Institutions - Stanford Hospital & Clinics Participates In Bay Area First
May 10, 2018
Twenty-four hours after she donated one of her kidneys at Stanford Hospital & Clinics, Josephine Soriano picked up the bedside phone and called her husband. He also was recovering from kidney surgery, on the floor just below her.
"We each said something like, 'Are you OK?'" Soriano recalled, as she talked with a visitor 48 hours after her surgery.
Both patients were, in fact, doing fine. Out of bed, walking, eating, and joking with their doctors and nurses.
But they also admitted to having some questions. Josephine Soriano didn't know where her donated kidney had gone, and Allan Soriano didn't know whose kidney he now has.
In a first-of-its-kind collaboration in the Bay Area, transplant surgeons from Stanford Hospital and California Pacific Medical Center joined specialists from Ronald Reagan UCLA Medical Center and New York-Presbyterian Hospital/Weill Cornell Medical Center in a set of carefully orchestrated surgeries that started on the morning of Nov. 19. "All the donors went to sleep at about the same time," said Marc Melcher, an assistant professor of surgery at Stanford who specializes in kidney and liver transplants and performs about 15 living-donor procedures per year. "Otherwise, with the time differences, you can imagine that a donor could back out once he found someone was asleep."
First, the surgeons extracted kidneys from three donors who did not know one another. Two of the kidneys made transcontinental trips on commercial flights, triple-bagged and packed in ice, and one kidney was shipped within the state of California. Later that same day, the kidneys were implanted in three recipients who, again, were total strangers.
Patients and physicians who've participated in these transplants are excited about their potential because, first, the kidneys come from living donors - and will last double the time of a deceased-donor organ. Moreover, a so-called "leftover" donor remains from the daylong series of surgeries. The remaining donor waits at one of the institutions, ready to donate a kidney when a compatible recipient is found. He enables the chain of kidney donations to continue, to be potentially "never-ending."
"By getting multiple universities together and cooperating, you can maximize the number of [donor-recipient] pairs that are possible and get more people transplanted," said Melcher, who is spearheading the new effort at Stanford. "And the 'chains' give us an opportunity to work together in ways that we all benefit from, and encourage us to communicate instead of competing in isolated towers."
Melcher said the never-ending chains of live kidney donations are the latest response to the growing list of sick patients who have to wait years for transplants. The chains are emerging at a time when the United Network for Organ Sharing reports that more than 82,000 patients in the United States are waiting for kidney transplants. At Stanford, 956 patients are waiting for donated kidneys, eight are waiting for kidney and pancreases, and two are waiting for pancreases. "And 3,000 to 4,000 people in the U.S. are dying every year, waiting for kidneys," Allan Soriano noted. "So we're hoping the chains will make more kidneys available."
The chain was the idea of New York software developer Garet Hill, whose daughter lost kidney function when she was 10. He wanted to donate a kidney to her, but their blood types were incompatible. A cousin ultimately was found to be a match and successfully donated a kidney.
Wanting to spare other families the anguish of long waits, Hill founded the National Kidney Register (kidneyregistry) last year to match donors and recipients through a complex computer program. "We went live in October 2007, and started our first chain on Valentine's Day 2008, when three transplants were done at Cornell," he said in a telephone interview. As a result of working with 15 academic medical centers, the registry now has some 600 non-directed donors on its lists. "And about 13 are in transplant centers now, being worked up," Hill added.
Stanford's Melcher and Mojgan Haririfar, manager of the adult kidney transplant program, attended a presentation Hill gave at CPMC last September, and came away believers. "With his program, you have the extra variable - the non-directed altruistic donor -which adds significantly more permutations and possibilities," Melcher said. "It increases the chances of finding a nice match, it's easy to use, and it's free and well thought-out."
The chains are an outgrowth of "swaps" or "paired donations," in which a pair of individuals, usually relatives - one sick recipient and one healthy donor who are not immunologically compatible - are matched with another donor-recipient pair whose blood and tissue types permit transplants between the pairs. But the exchanges stop there, among four people. Chains, by comparison, begin with an altruistic donor who is "non-directed" - willing to donate a kidney without knowing anything about its intended recipient - and they end with a leftover donor, who waits to make a life-saving gift. "These donors," Hill said, "walk on water."
He could be talking about Josephine Soriano. The 39-year-old contract recruiter for Yahoo watched the health of her husband Allan go steadily downhill during the past two years, the result of a condition that had been detected in 1985. Stanford physicians put Allan on the list of those waiting for deceased-donor kidneys, but the Sorianos knew it could be eight years before he would become eligible for an organ.
"I said, 'we've gotta do something,'" Josephine Soriano recalled. "I had heard about the chains, and for me it was, like, 'Of course I'd do this, because in the end, Allan's going to benefit from it.' It was only later that it dawned on me that many other people would also benefit."
The Sorianos had long conversations with Soo-Yee Kong, Stanford's living donor coordinator, with Melcher and with Stephan Busque, MD, head of Stanford's kidney-pancreas transplant program. "They were very open and answered all our questions," Allan Soriano said. "Dr. Melcher even gave me his cell phone number, and I did call him."
Melcher registered the Sorianos on Hill's Web site, and matches were found in a matter of weeks. In preparation for the surgery, Allan Soriano, a 44-year-old engineer at National Semiconductor, tracked down helpful Yahoo news groups, corresponded with kidney recipients in Ireland and Spain and poured over a huge red binder of rules and guidelines for medications.
He felt confident about how the chain would work, but he was worried about how his wife, who had never before been hospitalized, would deal with surgery. It helped to know that Busque and Melcher would be performing a minimally invasive procedure that used three 1-centimeter "ports" to insert laparoscopic tools and another, 8-cm incision to remove the kidney.
Josephine Soriano said there were "points when I became nervous," but she was committed. "I felt like God made me relatively healthy, and that I could do this. It was a no-brainer. Why wouldn't I do this?"
The Sorianos arrived together at Stanford Hospital on the morning of Nov. 18. They shared a room that night, and at 6:15 a.m. the following morning, Allan watched as Josephine was wheeled out to an operating room. Her procedure took about four hours, his almost three hours. Within 24 hours, they were chatting by phone from their respective rooms, separated because their surgeries required different levels of care.
"We're glad we're both past the surgery, but I also know this is just the beginning of the next phase for Allan," Josephine Soriano said. "He'll be on meds for the rest of his life, so it's a longer journey for him."
Allan Soriano said he was eager to take the first steps, encouraged by his wife's selfless act. "The donors don't have to do it. But we want to get the word out that they can."
About Stanford Hospital & Clinics
Stanford Hospital & Clinics is known worldwide for advanced treatment of complex disorders in areas such as cardiac care, cancer treatment, neurosciences, surgery, and organ transplants. Ranked #16 on the U.S. News and World Report annual list of "America's Best Hospitals," Stanford Hospital & Clinics is internationally recognized for translating medical breakthroughs into the care of patients. The Hospital is part of the Stanford University Medical Center, along with the Stanford University School of Medicine and Lucile Packard Children's Hospital at Stanford.
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