Giving life despite limits

Becky Borchert, a Wisconsin nurse, was eager to donate a kidney to her gravely ill friend in New York, but she had type A blood and her friend had type B. Richard Krafton, a school administrator in Massachusetts with advanced kidney disease, had the opposite problem: The friend who wanted to give him a kidney had type B blood, not a match for Krafton's type A.

But last week, Borchert saved her friend's life by giving a kidney to Krafton, a man she did not know, in the first test of a system that brings together strangers to exchange organs for transplant. At the same moment that surgeons at Massachusetts General Hospital began removing Borchert's kidney for Krafton, another surgical team at New York Presbyterian Hospital started taking a kidney from Krafton's friend, Steve Proulx, to implant in Borchert's friend, who asked to remain anonymous.

''This transplant could not have happened if we didn't have this program available," said Dr. Dicken Ko, who transplanted the kidney into Krafton.

Organizers say the New England Kidney Exchange, a computer system that matches kidney disease patients with compatible organ donors, could eventually arrange 2,000 to 3,000 transplants a year if applied nationally, giving people like Krafton a way to shortcut the current three- to seven-year wait for a transplant. Krafton got his new kidney and a second lease on life in just under a year.

''Right now, I feel great; I have more energy than I have in a long time," said Krafton, 54, who was padding happily around the transplant clinic in his stocking feet Friday, three days after surgery. Previously, he required three weekly sessions on dialysis to purify his blood as his kidneys gradually failed, leaving him chronically exhausted.

For 2,351 New Englanders awaiting a kidney from a cadaver, the exchange (www.nepke.org) gives them hope that a willing donor could help them if a relative's or friend's organs are incompatible. For example, a patient with type A blood and a mismatched donor with type B blood would be listed together on the exchange and matched with a pair who have the opposite mismatch (type B patient, type A donor), allowing two transplants to take place.

Currently, 18 kidney disease patients and 21 potential kidney donors are listed at the exchange. Transplant officials expect the exchange to grow as word of its existence spreads.

Until now, organ donations between strangers have been limited to arrangements among individual hospitals in New England and through such websites as MatchingDonors.Com, which says it has arranged 20 transplants between altruistic strangers. Transplant officials say Krafton's transplant signals the start of a more systematic approach and one that gives patients an added incentive to recruit new organ donors, potentially expanding the total supply. More than 65,000 people nationally are waiting for a kidney transplant.

''The transplants at Mass. General and [New York Presbyterian] are a wonderful example of . . . what is not widely done across the country, but should be," said Dr. Francis Delmonico, president of the United Network for Organ Sharing, which manages the national organ transplant supply. ''It is my intention to create a national system" modeled on the New England exchange, he said, adding that New York Presbyterian had already been placed on the exchange on an individual basis.

But transplant officials must proceed cautiously in encouraging living organ donations. Though people usually live normal lives with one remaining kidney, kidney donation carries some risk, and a handful of donors have died, though none at Mass. General. Since the donors don't need the surgery for their own health, doctors try to make sure donors understand the risks and are not coerced or bribed in any way. In fact, federal law forbids any payment in exchange for organ donation.

Borchert, a hospice nurse in Madison, Wis., said she knew the hazard, but never hesitated to offer a kidney when the cousin of one of her close friends from nursing school faced eventual death if she did not get a new kidney.

Dr. Tatsuo Kawai, who removed the kidney from Borchert, said kidney donation has become less traumatic for the donor now that the surgery is done using laparoscopic instruments through a small incision, greatly reducing the healing time from conventional surgery.

''Other than being a little tired, I'm fine," said Borchert, 46, dressed in a tie-dyed shirt and street clothes as she prepared to fly home Friday. ''I was walking the day of the surgery. I can go back to my normal routine in the next two weeks."

Nonetheless, Kawai said, it was important that the organ swap be roughly even. The donors' kidneys had to be of roughly equal quality and durability, he said, ''Otherwise, it's not fair," because one patient is getting an organ in better condition.

In addition, the organ exchanges are done at exactly the same time, requiring four surgical teams at two hospitals to simultaneously carry out a surgery that lasts more than four hours. If surgeons discover a last-minute problem that halts one organ donation, Kawai said, they have the option of stopping the other surgery if it is still at its early stages. Otherwise, he explained, there is a risk that a donor might undergo surgery without any benefit for their loved one.

Last week at Mass. General, there was only affection between Borchert and Krafton, who did not even meet until after the surgery. ''It takes a unique individual to do this," said Krafton, who brought his digital camera to get pictures of the two together. For her part, Borchert repeatedly hugged the man who received her kidney.

Alvin Roth, a Harvard University economist who helped design the kidney-matching system, said it may take a while before such scenes become commonplace. US Justice Department officials have argued that Congress needs to amend the National Organ Transplant Act of 1984 to make clear that such exchanges are legal. (New England transplant officials say their system is legal, but that stance hasn't been tested in court.)

Still, last week's transplants ''are a great accomplishment," Roth said. ''There are going to be more of these."

Scott Allen can be reached at allen@globe.com.