November 21, 2003

VUMC performs state’s first paired exchange kidney transplant

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Patricia Dempsey (top left) gave a kidney to Kay Morris (bottom left), Morris's daughter, Melissa Floyd (top right), gave a kidney to Tom Duncan, Dempsey's neighbor. Dana Johnson

VUMC performs state’s first paired exchange kidney transplant

The lives of two West Tennessee families have been changed forever by the generous act of organ donation, but not in the way they had originally planned.

Last Thursday, Kay Morris, 53, of Paris, Tenn. and Tom Duncan, 40, of Jackson, Tenn. received new kidneys in what became Vanderbilt University Medical Center’s and Tennessee’s first paired exchange, or double swap kidney transplant. Morris was to receive a kidney from her daughter, Melissa Floyd, and Duncan, from his friend and neighbor, Patricia Dempsey.

But, there was a positive cross match with both couples.

A cross-match is a blood test that mixes a sample of the recipient’s blood with cells from the donor’s blood to make sure the patient does not have antibodies that would react with the donor kidney. If there is no reaction, the operation can be done. If there is a reaction, known as a positive cross match, the transplant can’t take place.

Although both pairs were evaluated separately, Debbie Crowe, Ph.D., an astute Nashville immunologist who works for the laboratory that does Vanderbilt’s tissue typing, discovered that by swapping kidneys between the two pairs, the transplants would work.

Jeanne Hopkins, clinical renal transplant coordinator at VUMC, was instrumental in helping coordinate the transplants, including approaching one of the donors to find out if she would be willing to donate to a stranger so that her loved one could receive a kidney. Hopkins asked Floyd if she would be willing to donate to Duncan, and Kathy Brisendine, a nurse for Dr. Keith Johnson, Duncan’s physician in Nashville, asked Dempsey about donating to Morris.

“We believe the donors were the real heroes in this,” Hopkins said. “They really helped four people, the two who received the kidneys and the two spots they opened up on the transplant list. We’re so excited for the recipients. We’re glad it happened.”

Hopkins said that it wasn’t quite as hard to ask Floyd, who desperately wanted a kidney for her mother, as it was to ask Dempsey, who had planned to donate to a friend. “Kathy (the nurse who asked) told Patricia to take her time and think about it, then just left her alone. She called us back and said she would be glad to do it.”

The four people met for the first time in a clinic waiting room last week when they came to Vanderbilt for their pre-operative evaluations. The surgeries were performed by Drs. David Shaffer, professor of Surgery, and William A. Nylander Jr., associate professor of Surgery, in two operating rooms, back to back — Morris’s first, followed by Duncan’s.

Until recently, to be considered as a live donor, you had to be related, either emotionally or biologically to the recipient, and your blood and tissue type had to be compatible with the recipient. These requirements left about 10 percent to 20 percent of willing donors unable to help recipients, who were then forced to wait for a cadaver kidney.

Dempsey, 30, said she and Duncan have lived across the street from each other for the past six years. Her daughter, Blakely, 12, is the best friend of Duncan’s son, Thomas,14.

“It wasn’t a hard decision for me,” Dempsey said. Tom has had kidney failure for as long as I’ve known him. I wanted to help.”

Duncan, who has been on dialysis since 1999 and on the waiting list for a kidney for three years, said there are no words to thank Dempsey for her gift. “I can’t believe that she did this for me,” he said. “It’s awesome and is a sign the Lord is at work.”

Floyd, 34, said her mother has been on dialysis for two years. “I have been so worried about my Mom and wanted her to get off dialysis. I love people, and if I can help someone, I’m going to do it.”

Morris said she is touched by the generosity of Dempsey and her daughter. “It’s wonderful that they would do something like this, because they care about people that much.”

Vanderbilt’s kidney transplant program was established in 1962, one of the first in the country, and now one of the largest in the United States with approximately 100 procedures performed annually and more than 2,500 since the program’s inception. About half of the kidneys for Vanderbilt transplants come from cadavers and half come from living donors.

According to the National Kidney Foundation, more than 20 million Americans, or one in nine adults, have chronic kidney disease. Each year more than 70,000 Americans die from causes related to kidney failure. The number of kidney transplants performed each year exceeds 14,000.

Other institutions have performed similar double swaps, and in July 2003 Johns Hopkins performed what is believed to be the world’s first triple swap kidney transplant, providing healthy kidneys to a woman from Miami, a woman from Pittsburgh and a child from Washington, D.C.

The Vanderbilt patients, who recuperated on 10 South at Vanderbilt University Hospital, were all discharged by Tuesday, except Duncan. Shortly after the transplant, the nurses on the floor presented Shaffer, who came to Nashville in 2001 from the Boston area, with a cake. On the cake, written in icing, was “congratulations on your first southern swap.” n