'Triumph of the human spirit'

Surgeon says medical marathon, a first, done under a legal cloud

By Frank D. Roylance

Sun Reporter

November 21, 2006

5-way transplant (Sun news graphic by Lamont W. Harvey)

Honore "Honey" Rothstein, Kristine Jantzi (Sun photo by Kenneth K. Lam)

Leslie Persell, Sharon Brooks (Sun photo by Kenneth K. Lam)

Five kidney patients from across the country have received new organs from five unrelated living donors in what doctors at Johns Hopkins Hospital called the first five-way kidney swap in medical history.

The 10 surgeries took place last week in an all-day marathon that required more than 100 surgeons, nurses and others working simultaneously in five operating rooms.

All of the patients were recovering yesterday, and several were wheeled into a news conference, where they expressed gratitude to doctors and donors for a new lease on life - and amazement at the scope of the medical enterprise. Their doctors, meanwhile, took the opportunity to promote a change in federal law that would clear the way for such efforts on a national scale.

A tearful Kristine Jantzi, 40, of Bangor, Maine, who had been in kidney failure since the age of 7, clutched the hand of her donor, Honore "Honey" Rothstein, a healthy, 48-year-old West Virginian whom she had just met.

"I'm looking forward to restarting my life, as an adult - hopefully one with more freedom and better food," Jantzi said as Rothstein grinned beside her.

But the Hopkins surgeon who led the complex project said this "triumph of the human spirit over adversity" was carried out under a legal cloud that Congress might have created unintentionally 22 years ago.

"The legality of what we have done here is unclear, yet no one who has a mind or a heart could say that it was wrong," said Dr. Robert Montgomery, an associate professor of surgery and director of the Comprehensive Transplant Center at Hopkins.

The legal question stems from 1984 National Organ Transplant Act, which states that no one may receive money - or anything else of value - in return for donating an organ. Enacted long before kidney swaps among unrelated, living people were contemplated, the law was designed to prohibit a commercial market for human organs.

In a kidney-paired donation, no money changes hands, Montgomery explained. But, he said, "You are donating a kidney to someone you don't know, with the presumption that your loved one will receive an organ in return."

As a result, he said, the United Network for Organ Sharing, which coordinates organ transplants nationwide, is reluctant to replicate these organ swaps on a larger scale that could save thousands of lives.

Joel Newman, a spokesman for UNOS, said there has never been a formal opinion from the courts, Justice Department or federal regulators specifically barring these paired donations. "We're certainly in agreement that more living donor transplants could take place if there were a national coordinating registry," he said.

Newman and Montgomery said they have approached congressional staff members and Maryland Gov. Robert L. Ehrlich Jr.'s office for help passing legislation to exempt paired organ transplants from the federal organ trafficking ban.

A bill to that effect stalled in the current Congress, and no one expects action until the new Congress is sworn in.

"We are in the midst of a crisis in organ transplantation," Montgomery said. There are about 70,000 Americans currently undergoing kidney dialysis. They wait more than five years, on average, for a compatible organ to become available. Most are donated by deceased individuals.

Of those on the waiting list, Montgomery said, "Three thousand will either die waiting, or become too sick to receive a transplant."

An estimated 6,000 patients on the waiting list have friends or family members ready to donate one of their kidneys to save a loved one's life. But they can't do that because their tissues or blood type are incompatible. Implantation would risk an immune reaction that would destroy the new organ.

"Three thousand of those could be immediately transplanted if we had a national registry for kidney paired donations," Montgomery said.

Much of the work needed to establish a national registry had been done when doctors encountered the potential legal issue. "As soon as that legislation goes through, we are poised to start a national program," Montgomery said. "It would probably take a year or two."

Last Tuesday's surgeries at Hopkins began when four kidney patients went to Hopkins, each with a willing, but medically incompatible parent or spouse.

It was Rothstein who started the dominos falling in a scheme that allowed all four patients, and a fifth who had been waiting years for a new kidney - to get their new organs.

After Rothstein's first husband, Barry Castleman, died at 48 of a brain hemorrhage, all of his organs were donated. Amid their grief, Rothstein said, she and her children derived "great joy" from the notes they received from the recipients. "In a moment of desperation, you look for something good," she said.

When her daughter, Summer Castleman, 24, subsequently died of a drug overdose, none of her organs could be shared. So Rothstein offered her kidney in honor of Summer, whose framed photograph she clutched yesterday.

Her kidney went to Jantzi, whose mother, Florence Jantzi, a 65-year-old missionary from Ontario, donated a kidney to George Lonnie Brooks, 52, a semiretired mechanic from Clermont, Fla.

(When Brooks excused himself from the news conference yesterday to visit the men's room, Montgomery smiled like a proud father. "It's working," he said. "It's a beautiful thing.")

Brooks' wife, Sharon, 55, a telephone company maintenance administrator, gave a healthy kidney to Gary Persell, a 61-year-old retired film distributor from Sherman Oaks, Calif., while Persell's wife, Leslie, 61, a retired history teacher, gave her kidney to Gerald Loevner, a 77-year-old retired real estate developer from Sarasota, Fla.

Finally, Loevner's wife, Sandra, 63, a former marathon runner, gave a kidney to Sheila Thornton, also 63, a retired Baltimore City elementary school teacher from Edgewood.

Thornton said she had been waiting for a kidney from a cadaver since going on dialysis in 2003. Her condition had forced her to retire from teaching at Sinclair Lane Elementary, after 36 years on the job.

When Sandra Loevner's kidney proved a match, she said, "I just couldn't believe it. I was hoping for a cadaver, and I got a live one. That's a miracle."

Only a week after the surgery, and not yet discharged, she said she already felt different: "The biggest thing, I think, is the energy level. I'm just feeling vibrant."

Thornton said she looked forward to "cleaning my home - simple pleasures." She also plans to campaign with Montgomery for a national network for kidney paired transplants.

Gerald Loevner's transplant was performed by Dr. Dorry Segev. It was Segev's work in "optimization theory" (with his wife, Naval Academy math professor and Hopkins researcher Sommer Gentry) that demonstrated how an optimized national registry could save hundreds of lives and hundreds of millions of dollars now spent on dialysis.

Hopkins doctors performed the first kidney paired transplant in 2001, and the first three-way domino transplant in 2003. In all, 41 Hopkins patients have received new kidneys through kidney paired transplants - more than any center in the nation.

But growth of the program has been slow. Nationally, just over 100 patients have received kidneys through paired donations.

Hopkins' five-way transplant marathon may have been more challenging logistically than medically, Montgomery said.

Transplant nurse coordinator Janet M. Hiller and nurse clinician Katherine Stegner got the credit for making sure everybody showed up in the right place, on time. Some unrelated surgeries went on as scheduled, but others were postponed to free the operating theaters and staff for the transplants.

The operations were done simultaneously, on a single day, Montgomery said, to minimize the variables and unforeseeable events that might contribute to problems and bad outcomes.

The work got under way at 7:15 a.m. All five donors were wheeled into five operating rooms, where their healthy kidneys were removed, cleaned and prepared for implantation. The kidneys were removed by 11 a.m. The donors went to recovery rooms, while their kidneys remained behind, on ice.

At 1 p.m., after the operating rooms were cleaned and prepared, the five kidney recipients were wheeled in. All five implants were finished by 5:15 p.m.

All the kidney donors were released from the hospital by Friday. Each will be monitored for the rest of her life to make sure her remaining kidney continues to function well, doctors said.

The average kidney donated by a live donor functions for 18 to 20 years, twice as long as one from a cadaver.

Copyright © 2006 by The Baltimore Sun.

This article posted December 3, 2006.