National organ swap wanted

The program would allow patients and loved ones to do paired organ exchanges.
CHICAGO (AP) -- Kidney transplant specialists pushed Thursday for a national organ swap program that they say could be lifesaving for thousands of ailing patients on transplant waiting lists.
The swap, already done at about 30 U.S. hospitals, would involve patients who need transplants and have relatives or friends willing to donate but whose kidneys aren't a match. Each patient-donor pair would be matched with another pair to allow reciprocal transplants.
"It's quite a gift," said Ron Lazar, of North Canton, Ohio, who received a kidney transplant at the Cleveland Clinic in November after his doctors found a nearby Ohio couple in the same predicament.
Lazar's wife, Kathy, had the wrong blood type but her kidney was a match for Debbie Pratt, who like Lazar, had life-threatening kidney disease. And Pratt's husband, Gary, turned out to be a match for Ron Lazar.
"I feel like it was good luck and a prayer that we came up with a match," Lazar, 57, said Thursday.
Creating a national "paired kidney exchange" would allow transplants for about half the 6,000 U.S. patients yearly who have willing donors with incompatible kidneys because of different blood types or other reasons, said Dr. Robert Montgomery, director of Johns Hopkins University's Comprehensive Transplant Center.
"The payoff is huge," said Dr. Montgomery, who organized a conference in Chicago where dozens of specialists gathered to develop a blueprint for a national paired organ exchange program.
Long wait
There are more than 60,000 U.S. patients awaiting kidney transplants; last year 3,718 on the waiting list died because suitable organs couldn't be found in time, according to the National Kidney Foundation.
The average wait is three to four years, and while there are more living than deceased kidney donors, most transplants involve deceased donor organs because two kidneys can be taken from each cadaver. Paired organ exchanges shorten waiting times and provide kidneys from live donors, which are preferred because they improve patients' chances of survival, Montgomery said.
About 50 patients have received kidneys through U.S. paired organ exchange programs. Similar programs exist overseas in the Netherlands, Israel and South Korea.
Some 22 patients have received kidneys through the paired exchange program at Johns Hopkins, one of the nation's first, which began in 2001. Johns Hopkins also did the world's first known three-way swap, bringing six strangers together for simultaneous operations at the Baltimore hospital in 2003.
Existing programs
New England Medical Center and Medical College of Ohio are among other U.S. hospitals that take part in paired kidney exchanges. Conference participants included specialists from those institutions and the United Network for Organ Sharing, the national group contracted by Congress to coordinate transplants from cadaver donors to U.S. patients waiting for donated organs.
Governmental involvement might be required, Montgomery said, since UNOS is not contracted to allocate organs from living donors.
But Dr. Frank Delmonico, UNOS vice president and medical director of the New England Organ Bank, said UNOS would not necessarily have to be involved.
He called the conference "an affirmation of this process -- that it benefits patients."
Despite logistic and ethical hurdles, a national organ swap program likely will be established and the Chicago conference is a step in that direction, said Sheldon Zink, director of the University of Pennsylvania's Program for Transplant Policy and Ethics.
"The transplant community and doctors and family members are desperate to get organs for people on the waiting list, and this is just another way in trying to do that," said Zink, who did not attend the conference.
Zink said she supports the concept, but she said it needs to be implemented carefully, with safeguards to help make sure that donors aren't coerced into participating.
Potential problems
Also, transplant surgery is a major operation for donors and recipients, and recovery times tend to be longer and transplant-related emotional difficulties greater in donors who aren't closely related or who live far from recipients, Zink said.
She said those problems could be exacerbated by a national swap program.
But Debbie Pratt, 50, who was on dialysis for six years before she learned about the Lazars last year, said creating a national swap program would be "wonderful."
The couples have since become friends.
"They were our support system," Kathy Lazar said.
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