The waiting list for kidney transplants is a catalog of heartbreaking stories. Siblings who want to give the gift of life but are not compatible donors. Parents who are devastated when they hear the one gift their child needs is out of reach. Friends who build up the courage to donate, only to hear they cant help after all.
But national registries and old-fashioned planning by nurses have created new hope for patients waiting for renal transplants.
A tool called paired kidney exchange registries allows transplant centers to track pairs of incompatible donors and recipients and facilitate matches with others in a database. The potential donors, frustrated by their incompatibility to their loved ones, are willing to offer an organ to someone else in exchange for an organ for their family member or friend. The registry matches donors and recipients from one to another, forming a chain of giving.
In the spring, transplant teams at Newark (N.J.) Beth Israel Medical Center and Saint Barnabas Medical Center in Livingston, N.J., affiliates of the Saint Barnabas Health Care System, used the registry to partner with a team at NewYork-Presbyterian/Weill Cornell Medical Center in New York City in a six-way chain of generosity and gratitude.
This kind of chain is becoming more common as organ registries become larger, says Marie Morgievich, RN, APN, C, CNN, CCTC, renal transplant nurse practitioner at Saint Barnabas Medical Center. She notes transplant centers can benefit their patients by working closely together and using a more global approach to treating patients collaboratively.
Marian Charlton, RN, CCTC, chief coordinator of the Kidney and Pancreas Transplant Program at Weill Cornell Medical Center, has been involved in these efforts for several years and agrees. The collaboration among all the centers is amazing, she says. The centers have to be altruistic, and they put donors into the registry so that everyone can benefit from the availability. These exchanges cross cultural, religious, and ethnic lines such things just never come up. The donor is happy to give, and the recipient is even happier.
Nurses Make It HappenMarie Morgievich, RN
The foundation for these exchange programs is collaboration among transplant centers and the cornerstone is the nurse coordinator at each facility. These nurses are in frequent contact and are negotiating solutions as problems occur. They coordinate schedules and shipping arrangements to get the kidneys where they are needed in the shortest possible time.
We often ship the kidney to the recipient because it can be hard for donors to travel, Charlton says. There are times the donor is in California and the recipient is on the East Coast. The coordination among transplant centers is a massive undertaking.
Morgievich and Charlton agree the nurses who coordinate the exchanges are the driving force that makes the whole complex machine run. Larger transplant centers are the major players because they have the expertise and resources to be innovative about approaches to exchanges.
Operating room schedules have to be coordinated, and detailed logistical communication schedules are set up across miles and time zones, so that as the living donor kidneys are removed and prepared for transport across the hall or across the continent, the recipient is ready. Although the surgical procedure is similar in every case, surgeons share details about the anatomy of the organ with the receiving surgical team.
The goal is always to have the surgeries take place as close to simultaneously as possible to minimize the risk the donor will change his or her mind. Another consideration for the quick turnaround is to implant the organ as soon as possible to minimize the cold ischemic time the donor kidney is out of the body and promote immediate graft function in the recipient.
Charlton is continually impressed by the collaboration and cooperation among the transplant centers that participate in the living donor kidney exchange programs. She works regularly with nurses around the country who she rarely sees. Timing and coordination problems that would give a NASA launch team pause are routinely overcome by this cadre of nurses.
According to the Alliance for Paired Donation, the average living donor kidney functions for 15-1/2 years and the average deceased donor kidney functions for about half as long.
New Ways to Describe Care
Morgievich notes that if anyone entered kidney exchange into an Internet search engine five years ago, they would have had negligible results. A Google search today produced 1.2 million results in less than a second.
This is a whole new ball game, and weve had to create new ways to look at sharing best practices. Weve even had to create a language for the way it works, she says. When we have paired donor and recipients combined with an altruistic donor, we usually have a donor at the end of the chain. We sometimes hold that donor over or find an appropriate recipient from the wait list. That last donor in the chain is called a bridge donor because sometimes they wait until we can organize another series of exchanges. They are the bridge to the new chain.
In the case of the six-way exchange that occurred this spring, the chain was closed by a transplant to a person on the waiting list. Morgievich remembers making the call that changed his life.
He spent years on dialysis, and he was overwhelmed by the gift, Morgievich says. For someone who has been waiting for so long, getting that call is everything. There are nearly 80,000 names on that list, waiting for the phone to ring. Using the living donor exchange registries might make those calls more frequent, offering more people the hope for a new life.