Kidney chains, a string of transplants for patients and donors, help to save multiple lives

For 30 years, Gail Shaevel’s kidneys slowly gave up on her.

Three times a week, from 2004 until 2008, she sat for three-hour dialysis sessions. Machines filtered her blood for her, because her kidneys couldn’t do the work they should.

Shaevel and her family couldn’t go on family trips for more than a weekend to keep up with the dialysis. She even gave up her career working with children, because the autoimmune disease meant she was more likely to get sick often.

Gail’s husband Steve Shaevel, director of academic personnel for the UCLA School of Dentistry, couldn’t donate a kidney because they have different blood types, and none of their family or friends stepped up to donate.

So the Shaevels thought she’d have to wait the seven or eight years it takes on the transplant waiting list to get a kidney from a cadaver.

But then in 2008, they participated in UCLA’s first kidney chain.

A kidney chain is a string of transplants that allows patients with failing kidneys to get a new one, regardless of whether the person who wants to donate to them is compatible or not.

If someone is willing to donate to a specific person with a failing kidney but can’t because they are incompatible, UCLA will enter both of their names and medical information into two national registries. Medical centers and hospitals throughout the U.S. use these registries, and when a match comes up for both of them, a chain of transplants is formed.

Kidney chains start with a donor who doesn’t expect anything in return ““ he or she wants to donate a kidney but doesn’t have a specific person in mind, said Suzanne McGuire, high risk and living donor exchange coordinator for the Kidney and Pancreas Transplant Program at UCLA.

Here’s a hypothetical situation: The first person donates to Patient A, who is compatible. In turn, Patient A’s friend or family member donates to someone else who is a match, and the chain continues.

It usually ends with someone on the kidney transplant waiting list who does not have a willing donor partnered with them.

“It’s strangers donating to other strangers. … There’s a real humanistic side to it,” said Jeffrey Veale, the UCLA kidney transplant surgeon who organized and operated in the first kidney chain, which involved eight transplants.

A chain had already been conducted on the East Coast, but this was the first for the West Coast. The Shaevels’ surgeries were done at UCLA ““ both Gail Shaevel and her donor had the surgery at the Ronald Reagan UCLA Medical Center, and a month later doctors removed one of Steve Shaevel’s kidneys and flew it up to Stanford, where the chain continued.

The Shaevels see kidney chains as a way to save two lives ““ the willingness to donate means the person you love will get a kidney, and someone else will benefit too, they said.

“It just makes total sense,” Steve Shaevel said. “If I was willing to give up a kidney (to save) my wife, why wouldn’t I give it to someone else?”

In just four years, kidney chains have multiplied in both number and length. The UCLA Kidney Program has conducted more than 60 transplants as parts of kidney chains.

A recent kidney chain in December involved 30 transplants, which involved 60 patients and spanned from New York to California. It’s the longest kidney chain in the world, and 16 of the surgeries took place at UCLA, McGuire said.

Now, Veale is involved in up to four kidney chains at a time. The transplants usually happen in clusters of three or four per week over a few months, until the chain is complete.

When Veale started working on kidney chains, they were a new concept, and he had to keep them on the smaller side because of all the coordination involved between medical centers. Now, more advanced technology and funding for a coordinator allows for longer chains, Veale said.

Kidney chains have pros and cons. Longer chains are riskier because there are more variables that could postpone a surgery or break a chain, McGuire said, but the number of possible combinations makes it more likely that even people with the narrowest parameters will find a match.

Organizing kidney chains can be daunting, McGuire said, but she’s rewarded when a difficult-to-match patient finds a donor, or when she sees how good a donor feels about saving two lives through their donation.

It’s up to McGuire and coordinators like her at each medical center involved in a chain to work with the patients and make sure they understand the commitment, as well as schedule the surgeries.

Of the more than 400 exchanges that have taken place through the National Kidney Registry, seven donors have backed out of transplants, McGuire said.

It’s illegal to sign a contract or provide compensation for organs, so the agreements are based on a promise, after physical and psychosocial evaluations to make sure a person is able to and committed to donating, McGuire said.

“It’s basically done on a handshake,” Gail Shaevel said.

Steve Shaevel said he never hesitated about following through on his promise, though his recipient in Northern California, Allan Soriano, said he didn’t expect to actually receive a kidney until the week before, when he had to start preparations for the surgery and take a leave from work.

The relationships between participants of a kidney chain vary. Gail Shaevel sends a thank you card to her donor every year, but she said her donor prefers to leave the interaction at that.

But what started as a kidney donation has turned into a friendship for the Shaevels and Sorianos. Steve Shaevel and Soriano email each other every few days, and, six months after the surgery, the two couples met for a lunch that stretched to almost four hours.