Seven Washington, D.C. area residents in need of kidney transplants, but with antibodies so high that a traditional donor match was virtually impossible, were successfully transplanted during four days in July, making it the largest kidney exchange of its kind to take place in one city.
All seven of the recipients received a procedure before and after the transplant called plasmapheresis, which lowers a person's antibodies in order to accept another person's organ. Doctors hope this is a way to address the racial disparities that exist in the area of kidney transplant and the African-American community.
"There are 6,000 people on dialysis in the D.C. area on a given day. We do about 200-250 kidney transplants a year at all hospitals in this city. Using plasmapheresis, we hope to double that number of kidney transplants," said J. Keith Melancon, MD, Director of Kidney and Pancreas Transplant Surgery at Georgetown University Hospital. Dr. Melancon was on the team that pioneered the use of plasmapheresis to address kidney donor compatibility and is the first to use it to address the racial disparities issue.
"I think some years ago, this is something we would have never tried, because we would have thought that these incompatibilities were too insurmountable," said Jimmy Light, MD, transplant surgeon and Director of Transplantation Services at Washington Hospital Center. "Perhaps they were insurmountable with the technologies we had back then. But now we know that these things are doable, and now, virtually anyone with a willing, living donor can have a transplant. Consequently, many, many more people can be helped than we thought." There are about 700 patients awaiting a kidney transplant at the Hospital Center.
On July 16, 17, 20 and 21, the organs were recovered and/or transplanted at Georgetown University Hospital and Washington Hospital Center, and in some cases, kidneys actually crossed town from donor to recipient.
The kidney exchange was kicked off July 16, with an altruistic donor, 29-year-old Jordan Brough of Alexandria, Va. His kidney went to 61-year-old great-grandmother Elizabeth Garner of Clinton, Md. On July 17, Craig McKinney of the District donated his kidney to 21-year-old Domenick Ray of Huntingtown, Md. On that same day, altruistic donor Linda Russell, a 60-year-old great-grandmother from St. Louis, Mo. donated her kidney to Oluremi Adetosoye, 54 of Silver Spring, Md.
On July 20, Larry McPhatter of Clinton, Md., who is also Elizabeth Garner's husband, had his kidney recovered at Georgetown to be sent via ambulance to Washington Hospital Center, and transplanted into 40-year-old Dachia Pinkard of Takoma Park, Md. On that same day, Terry Bond of Mechanicsville, Md., had her kidney recovered at the Hospital Center, transported to Georgetown and transplanted into 45-year-old Lori Sough of Kensington, Md. This was the third kidney for Lori, who has suffered with kidney disease since fourth grade.
On July 21, Bryan Pinkard, Dachia Pinkard's brother, donated to 46-year-old Jacqueline Bond of Mechanicsville, Md. This was the third kidney for Jacqueline, who is Terry Bond's sister. Also on the 21st, Shawn Ray, Domenick Ray's cousin, donated his kidney to 41-year-old Elaine Duboise of Washington, D.C.
Of the roughly 80,000 people waiting list for a kidney in the United States 36 percent are African American. Yet African Americans only receive about 15 percent of the living donor organs available.
"Given the prevalence of risk factors for kidney disease in the African-American community, it is extremely difficult for someone in need to find a donor who is a close enough match who is willing and medically able to withstand the donor surgery. If they can come to us with one willing donor, we can use plasmapheresis to match them with someone else who is a closer match, as we have done in this case," said Dr. Melancon. "This is a huge milestone for those who suffer from the twin ravages of diabetes and hypertension, and whose only way to survive is by dialysis. After the transplant, they will no longer need dialysis, which often takes three days a week out of a person's life, and leaves them tired and unable to work or go to school."
"When we have people willing to be donors, we need to try and make a transplant happen," said Dr. Melancon. "Until the past year in this city, before we started using plasmapheresis, we couldn't help these folks. They continued to languish on dialysis. Now, it's much easier for African-American people with kidney failure to get a transplant. As for the donors who come forward, it's breathtaking for me and the team. We really get to see the best side of humanity, man helping man; it's really beautiful."
-------------------------------------------------------------------
Joseph Keith Melancon, MD
Previously director of pancreas transplantation, Kidney Transplantation and Clinical Transplantation Research at John Hopkins Medical Institutions, Joseph Keith Melancon, MD joined Georgetown University Hospital in the newly created position of director, Kidney and Pancreas Transplantation Program. A 1991 graduate of the University of Louisiana, Dr. Melancon completed medical school at Tulane University, followed by his surgical internship, residency and research fellowship at the University's medical center. He then completed a transplant fellowship at the University of Minnesota before joining Hopkins in 2004.
Dr. Melancon's work has appeared in Lancet, JAMA, Transplantation, American Journal of Transplantation and Transplantation Proceedings, among others. He is a frequent presenter at such major medical meetings as the World Transplant Conference, the Living Donor Transplant Conference and the American Transplant Conference. An active researcher, he has served as principal investigator on many NIH and competitive trials and especially interested in racial disparities in transplantation and immune response as well as tracking transplanted islet cells in vivo. A board certified surgeon, Dr. Melancon is a member of the American Society of Transplant Surgeons, the Society of Black Academic Surgeons, the American Medical Association and the National Medical Association.
