Fourteen patients receive kidneys in world’s largest kidney exchange

By Pamela Bond

PennUnion (Johns Hopkins University’s literary journal)

May 6, 2011

 A tragic accident that killed a twenty-four-year-old mother of two became the tipping point that saved fourteen lives and changed thirteen others in 2010.

Jennifer Whitford, of Sebring, Florida, cut her hair and donated it to Locks of Love just days before her death. Her generous spirit is what spurred her mother’s decision to donate her organs.

“If my daughter’s organs can help others, that gives me incredible comfort,” Whitford’s mother, Denise Milliken, said. “She was such a giving young girl. I know she would approve and would be so pleased that her kidney will now allow another mother to finish raising her children.”

Whitford’s family donated her kidneys after her death, starting the world’s largest kidney exchange that occurred in Washington, D.C., from May twenty sixth to June twelfth, 2010. The exchange involved four area hospitals: Georgetown University Hospital, Washington Hopsital Center, Children’s National Medical Center and Inova Fairfax Hospital. Most of the donors and recipients came from the metro area, but some came from as far away as Maine and California.

In the kidney exchange, fourteen people received new kidneys. Whitford was the only deceased donor – the other thirteen donors were living. Receiving a kidney from a live donor greatly increases the amount of time that kidney will function in the new body. It is very hard to find a kidney match. Often, even close blood relatives don’t match.

So, in this kidney exchange, each kidney recipient had someone willing to donate on their behalf, but their kidney actually went to someone else they matched. Each donor was giving a kidney to someone they didn’t know, but in return the patient they were close to received a kidney as well.

Washington, D.C., has the highest per capita occurrence of kidney disease in the nation. Ten percent of the population is on dialysis and two hundred to two hundred and fifty transplants take place each year. Keith Melancon, M.D., director of the kidney/pancreas transplant program at Georgetown University Hospital, said that number should be twice as high.

“People don’t think of kidney disease so much as a life-threatening illness because of dialysis,” he said. “But life-threatening diseases accelerate once you’re on dialysis. And your life span is shorter. If you’re thirty-five and on dialysis, without a transplant you might not make it to fifty.”

Each human has two kidneys, which allows a donor to give one away and still be able to function normally. The kidney serves many functions necessary for survival. Primarily, it filters waste from blood and moves it to the bladder, which is the role dialysis takes when the kidneys fail. But the kidneys also regulate electrolytes and blood pressure, balance acid and base substances, produce hormones, and reabsorb water, glucose and amino acids. Therefore, dialysis is not a perfect solution to kidney disease because it does not replace all the functions of the kidneys.

Currently, more than eighty thousand people are on a waiting list for a kidney in America, according to the United Network for Organ Sharing. About twenty thousand deceased kidney transplants take place every year. The average waiting time for a transplant is two and a half years, but that can range from one month to five years. It’s harder for minorities to find matches and non-whites make up sixty-one percent of those waiting for a kidney, according to the U.S. Department of Health and Human Services.

African-Americans are four times more likely to have kidney disease than whites. This means that many of the people on the waitlist are African-American and there is less of a pool of good kidneys available for transplant. Melancon and Jimmy Light, M.D., director of Transplantation Services at Washington Hospital Center, are trying to change those statistics.

One method they are using is plasmapheresis, which was invented by Charles Drew eighty years ago in D.C. as a way of storing blood. The plasma is removed from the blood. The plasma contains proteins that build antibodies, which are what the body would use to attack a foreign element. This means that a person is more likely to accept a kidney. Normally, the donor and recipient must have many similarities, such as their race, but using plasmapheresis creates more potential donors.

The other method doctors in D.C. are using is these exchanges. The June exchange followed a thirteen-person kidney transplant exchange in December 2009, which held the previous world record. Doctors from different hospitals work together for months to find a donor connected with a recipient, and then find a recipient for that donor. Before Jennifer Whitford’s death, a thirteen-person exchange was planned, but her kidney was a perfect match to a recipient in the program so they were able to use her kidney and add another person.

“Those people literally needed a needle in a haystack,” Melancon said. “Minorities in particular find it extremely difficult to find a suitable donor using traditional donor match methods. By putting them in an exchange and giving them the option of a relatively new use of the blood cleansing technique called plasmapheresis, we can greatly increase their chances of getting a suitable donor as well as reduce their waiting time to get a transplant. In this exchange, five of the recipients received plasmapheresis before and after their transplants.”

Whitford’s kidney went to Brenda Wolfe, age forty-four, of Mt. Airy, Maryland, at GUH. Wolfe is a mother of two just like Whitford. Milliken said it was “amazing” that her daughter would help another mother raise her children.

Wolfe was unexpectedly diagnosed with an autoimmune disorder after a medical procedure last year. She had to be put on dialysis seven days a week and then found out she had renal failure and needed a kidney.

“We came to this exchange and were getting ready for it when I was told I had a perfect match from a deceased donor somewhere in the United States,” Wolfe said. “It was amazing, like I had a perfect twin somewhere.”

Wolfe’s husband, Ralph Wolfe, was already set to donate as part of the exchange when Whitford’s kidney became available. At this point, he had the chance to back out but decided to continue.

“I felt that if I backed out, I’d be going back on my word that I had given to someone I didn’t even know,” Ralph Wolfe said.

Ralph Wolfe’s kidney was removed on June eighth at GUH and transplanted to Gary Johnson, age sixty-three, of Hyattsville, Maryland, at WHC. While Ralph Wolfe is white, he was able to give a kidney to Johnson, who is black, due to the use of plasmapheresis. Johnson has been struggling with diabetes and high blood pressure for decades. His brother donated a kidney to him in 2003, but that only lasted two years before he needed dialysis again.

Johnson’s wife, Jeannette Johnson, age sixty-one, donated her kidney on behalf of her husband to an anonymous recipient, age forty-four, of Arlington, Virginia. Jeannette Johnson is a breast cancer survivor and has been married to Gary Johnson for forty years.

“This particular exchange is a beautiful example of how we need more donors of all kinds and how the different types of donors can come together and make this wonderful life-saving chain,” Melancon said. “Here, we have a deceased donor who started everything off. We have the donors who just donated because they were healthy enough and because they have a deep commitment to their fellow human beings, and you have the directed donors, the family members and friends who came forward on behalf of someone specific they cared about.”