"There's such a shortage of donors out there that when you have a donor, you want to make the best use of it," said Tania Makki, RN, recipient coordinator for Stanford's kidney transplant program. "These chains allow patients to be transplanted with a living donor, who may not have been otherwise."
According to the United Network for Organ Sharing, more than 80,000 U.S. patients are now waiting for kidney transplants, and the average wait time is five to seven years. Stanford has about 1,000 patients on its waiting list. Through donor chains, transplants can be arranged within months, and that can save lives, since kidney transplantation increases life expectancy compared with dialysis treatment.
Fred and Yvette heard about kidney donor chains in late 2007, after Fred was put on the waiting list for a transplant. Yvette was desperate to help her husband, who was on dialysis three days a week and was "going downhill," she recalled. "He was tired all the time. His skin color changed. He wouldn't eat. He couldn't sleep."
Yvette wanted to donate a kidney to her husband, but their blood types were incompatible. Complicating matters further, Fred's blood was sensitized against, or had antibodies against, roughly half the U.S. population.
Once Yvette learned about donor chains, she was immediately interested: "I told them if you want to do it, I'll donate right now," she said. After four months of tests at Stanford, and reviewing the small but real risks of donating a kidney, she was deemed healthy enough to donate. In February 2009, Marc Melcher, MD, an assistant professor of surgery who specializes in kidney and liver transplants, gave Fred and Yvette's information to the National Kidney Registry.
In September 2009, the registry contacted Stanford with a possible match for Fred and Yvette. The next step was to send their blood samples to the transplant centers involved in the cluster, to confirm the match.
The members of Stanford's kidney transplant team knew from experience that numerous factors had to be in place, and if any factor fell through—if any of the donors backed out, for example, or if anyone got sick—the whole chain could collapse. "You're always worried there might be a glitch and it won't go through. It's a rollercoaster of emotions," Makki said.
The long odds didn't dampen the Azizes' optimism. "When the doctors talked about the surgeries, they said, 'If, if, if…'" Fred recalls. "But I said I'm going to be positive."
By Sept. 25, 2009, all 16 patients in the donor cluster were cleared for surgery. The first operation took place at UCSF on Sept. 30. By Oct. 6, the remaining surgeries were still on schedule. Yvette went into surgery at 6 a.m. that day to donate her kidney, while a patient at UCLA was preparing to do the same. Both kidneys were shipped across the state on commercial flights, and that afternoon Melcher's team performed Fred's transplant. All 16 patients are recovering well.
While teamwork is important to the success of any organ transplant, it is particularly crucial in a complex donor chain, Melcher said. "We take a very team-oriented approach," he said. "Everyone has to work together: the nephrologist, the surgeons, the social workers, the nurse coordinators, the lab techs—everyone."
Melcher also praised the close collaboration among the five participating hospitals, with frequent communication among their nurses, surgeons, lab staff and more. "Remember, some of these institutions are competitors," he said. "But everyone worked together to do the best for our patients."
This effort didn't go unnoticed by the Azizes. "The whole team did a great job, from the lowest level to the highest. Their teamwork is 100 percent," said Fred, adding, "God bless every single person at Stanford."
The couple's oldest child, 23-year-old Amal, said she's looking forward to traveling with her parents to Egypt, and perhaps other destinations. After the heavy toll taken by her father's illness, she is glad to see him looking energetic again.
"This might sound corny," she continued, "but if it weren't for Stanford, my father might not be here today. They worked diligently to take care of him, and we're very thankful."
By Sara Selis.