Program pairing kidney donors, strangers reports great success

CHICAGO -- Researchers are reporting a high success rate for a kidney-swapping program between strangers that proponents say could someday ease the nation's shortage of transplant organs.

Most kidney transplants rely on organs taken from cadavers. But doctors prefer using organs from live donors, because the success rates are higher.

Over the past few years, a patient who needs a kidney could be matched up with a compatible stranger; in return, the patient must get a friend or relative willing to donate an organ to another stranger.

The practice is particularly useful in cases where a kidney patient's friend or relative is willing to donate an organ to their loved one but is not a suitable match.

Now, for the first time, researchers at Johns Hopkins University are reporting that ''kidney paired donations" actually work. Of the 22 ''paired" transplants the researchers studied, only one failed, because of clotting problems unrelated to organ rejection. That patient eventually received a kidney from a dead donor. Four patients also had treatable immune-system reactions. There were no deaths.

The patients were followed, on average, for 13 months, although two were followed only one month.

The success rates were comparable to other live-donor transplant rates, said Dr. Robert Montgomery, director of Johns Hopkins's Comprehensive Transplant Center and a coauthor of the study. The university's kidney-swap program began in 2001.

The study appears today in the Journal of the American Medical Association.

More than 63,000 US patients now await a kidney transplant, according to the United Network for Organ Sharing, or UNOS. In 2004, 3,897 patients died while waiting for a kidney.

Though the kidney-swap idea has been around almost 20 years, only 64 US patients have received a kidney transplant through a paired exchange, according to UNOS.

But ''the momentum is increasing for a national program," Montgomery said.

At a conference in March, he and other specialists gathered in Chicago to develop a blueprint for a national paired organ exchange.

Proponents hope a nationwide system could help relieve the organ shortage and cut costs by getting people off dialysis.

But such swaps involve logistical and ethical problems.

Dr. Lainie Ross of the University of Chicago, who with her colleagues wrote a 1997 paper laying out the ethical guidelines followed by Johns Hopkins, praised the research, but said there are still unknowns, such as how the donor and recipient will fare emotionally.

At Johns Hopkins, donors must talk to a psychologist and a social worker to make sure they do not feel pressured to participate, Montgomery said.

The operations studied were done simultaneously to prevent the ethical dilemma that could result if a donor wanted to back out of the trade.