Northwestern Memorial Hospital Continues its Leadership in the Advancement of Techniques to Expand the Living Donor Base
Physicians offer blood type incompatible transplant options, and a paired exchange program
Currently, there are more than 75,000 people on the United Network for Organ Sharing (UNOS) registry waiting for a kidney transplant, with over 3,500 people in Illinois alone. As waiting times for an organ increase steadily, the role of living kidney donors has become even more important. Institutions such as Northwestern Memorial Hospital, which has consistently been recognized as one of the top living donor transplant centers in the United States, are responding by offering a wide range of transplant options for patients.
While the increase in living donors in recent years has helped many, about one-third of willing living donors that come forward are not medically compatible with their intended recipients. Thankfully, medical advancements have provided new options to help people on the waiting list receive a donation. A new technique called ABO incompatible transplantation allows the donor and recipient who have different blood types to still move forward with transplant surgery, which in the past was not possible. Northwestern Memorial is one of only a handful nationwide that offer the technique, in which transplant surgeons desensitize the kidney recipient’s blood before the transplant takes place through a process called plasmapheresis, which cleans the antibodies in the blood so they do not attack the new blood type after the surgery. The organ recipient goes through a specific number of plasmapheresis treatments in the weeks preceding surgery, as well as several afterwards to ensure that the transplanted organ is not rejected.
“The emergence of this technique will allow us to transplant more patients when previously it wouldn’t have been an option because of their blood-type incompatibilities,”
says John Friedewald, MD, nephrologist at Northwestern Memorial Hospital. “That translates into even more options for those in need of a transplant, and more lives saved.”
Another option for living donors and recipients is paired exchange. Northwestern Memorial offers the paired exchange program to kidney donors and their intended recipients who are not viable matches for each other, but may be able to be matched with another donor and recipient who are in a similar situation. In this situation, the hospital makes each donor/recipient pair aware that the donor from one pair may donate to the recipient of the other pair, and vice versa. Then, it is up to the individuals if they wish to move forward with the transplant surgery. Northwestern Memorial is among a growing number of transplant centers offering this type of program.
Northwestern Memorial has a long history of leadership in the field of living donor kidney transplantation. In addition to these advancements in transplant surgeries, Northwestern Memorial was the first center in the Midwest to perform laparoscopic donor kidney transplants. The laparoscopic procedure is done on the kidney donor and requires several small incisions, rather than the traditional “open” procedure which left a large incision and scar. The transplant team has recently reached a milestone, performing over 1,000 laparoscopic living donor kidney transplant surgeries since the program’s inception 10 years ago.
“Northwestern Memorial is recognized as one of the nation's top five centers for laparoscopic kidney procedures,” says Michael Abecassis, MD, Chief of Transplantation at Northwestern Memorial Hospital. “And with the advent of laparoscopic kidney donor surgeries, including shorter hospital stays and a faster return to normal life, we’ve seen a change in people’s perceptions about being a living organ donor.”
Another benefit of the living donor transplant surgery is that there is no waiting period and the surgery can be scheduled at a convenient time for the donor and recipient. “An organ from a living donor often works sooner than an organ from a cadaveric or deceased donor, and typically lasts longer as well,” commented Joseph Leventhal, MD, PhD, transplant surgeon at Northwestern Memorial Hospital. “Immunosuppressive drugs are also much better now, which has allowed us to complete more transplants between people who are not identical or close relatives.” Northwestern is a prednisone-free institution as well, meaning that physicians do not use steroids as an anti-rejection drug in the vast majority of patients, as the side effects can cause significant health problems down the road.
To learn more about Northwestern Memorial’s living donor kidney transplant surgery, log onto www.nmh.org.