Paired kidney exchange saving lives

Innovative solution to organ shortage -- Program overcomes incompatibility

Elaine Carey

Health Reporter

April 1, 2006

In their desperate search for organs for transplant, patients and advocates are constantly searching for innovative solutions.

Yesterday, doctors from St. Michael's and Toronto General Hospital unveiled a new one -- the first Canadian kidney transplant paired exchange.

Two Toronto couples, both with one spouse dying of kidney disease and the other unable to donate one of their own healthy kidneys because they weren't a compatible blood type, came together anonymously to solve their joint problem.

Tom McCabe, an accountant in his early 60s, gave one of his kidneys to 46-year-old Joe Leung, a buyer for Wal-Mart, on Nov.29 last year at St. Michael's Hospital.

At the same time, Heidi Leung, 44, happily gave one of her healthy kidneys to Antoinette McCabe, in her late 50s, at Toronto General Hospital.

Joe Leung, the father of two teenage girls, has been a kidney patient for 16 years and had his first transplant in 1994 from a deceased donor.

"The first 10 years were wonderful and totally changed my quality of life," he said. When his kidney began to fail, he had to be hooked up to a dialysis machine every night from 9 p.m. to 6 a.m. so he could keep going to work.

"When I had this second chance, my wife just stepped out of the box and said `why don't we do it,'" he said, fighting back tears. "I am really grateful to have my wife and Tom to give me and Antoinette another chance."

Antoinette McCabe had been in renal failure for three years and had to go to the hospital for dialysis three times a week.

"The waiting list (for a transplant) was getting into the double digits and I knew she wouldn't survive that long," said Tom McCabe.

"Why did I do it? We've been married 34 years; I love her dearly. It's a simple as that," he said. "It's a wonderful program for anyone in my situation who wants to donate and can't."

Antoinette McCabe said simply she was extremely grateful to her husband and "my new friend and donor Heidi, whose kidney I will cherish forever. Also to her husband, Joe, who will cherish my husband's kidney forever. This is a great day for dialysis patients everywhere."

The operations to remove the healthy kidneys from the donors were performed at the same time so neither donor could back out at the last minute, doctors told an emotional news conference at Toronto General.

Earlier this week, the two couples met for the first time and "the social worker cried," Heidi Leung said.

Doctors very consciously decided to keep the donors and recipients anonymous, as have other programs like it, said Dr. Ed Cole, head of nephrology and renal transplantation at the University Health Network, which includes Toronto General. Then several months after the operation, they gave the two couples the chance to meet.

The complicated procedure required four operating rooms and a total of about 40 people on surgical teams in the two hospitals. Each kidney retrieval operation took 1  1/2 hours, each transplant about two hours.

Very few things in Canadian medicine are limited by the lack of resources like organ transplants are, said Dr. Jeffrey Zaltzman, director of the kidney transplant program at St. Michael's.

"We are at the mercy of organ donors," he said. "Paired exchange is one more way to increase organs for transplant."

More than 800 adults and children in the Greater Toronto Area alone and more than 1,000 in Ontario are waiting for kidney transplants. Many will linger on the list for eight to 10 years and about 2 per cent of them die each year waiting, Zaltzman said. The longer they wait for a transplant, the worse their outcomes.

Receiving a kidney from a living donor gives the recipient the best survival rates of at least 15 to 20 years, he said, while one from a deceased donor lasts from 10 to 15 years.

But for every three potential living donors, only one is able to give an organ to his chosen recipient because of incompatibility, Cole said.

Paired kidney exchange is now used in the United States, Europe and Asia and St. Mike's and Toronto General began discussing it two years ago.

When it finally happened in November, "we took two people who would otherwise have to go on the deceased donor waiting list and we got them an organ," Cole said. "We believe this is an important initiative, an opportunity to save lives."

"But it takes a lot of potential donors and recipients to many pairs that are actually feasible to transplant," he said. "We need in the range of 100 pairs to optimize such a system."

Now there are only about 10 pairs, so there is an effort to set up a computerized pair registry.

Copyright © 2006 Toronto Star Newspapers Limited.

This article posted April 23, 2006.