Triple kidney swap at San Francisco's CPMC has unique twist

After 12 years of doctor’s appointments and declining health reports, the waiting game was over for Dale Anderson. He needed a new kidney.

His wife, Denise, offered hers, but despite the 14 years the two had spent together, their organs were incompatible.

The fact that Denise’s kidney wasn’t a match was a minor detail — more importantly, she was a viable donor for someone else.

Click on the main photo to see a slideshow of the patients.

Friday, the Andersons were part of a three-way kidney swap at California Pacific Medical Center set up through a program that matched the couple with two other pairs in the same situation — one in need of a kidney, the other with one who is not a match.

While most donor kidneys are harvested from the dead, donations from the living are becoming increasingly popular and are among the best options for transplant candidates, said Dr. Steve Katznelson, medical director of California Pacific’s Transplant Department. That’s because more people need kidneys and waiting lists are longer for cadaver kidneys than for living donations.

Katznelson attributed the problem to an increase in the number of people with diabetes-related kidney failure and an extension of the age limit for transplants, from people in their 60s and 70s to people in their 80s.

Twenty years ago, wait-listed patients could get a kidney in about six months.

“If you don’t have a living donor option you could wait for years [now],” Katznelson said.

In contrast, within a month, CPMC had matched up, approved for surgery and wheeled into the operating rooms three people who would give their kidneys to strangers so someone they loved could live longer.

But live donations come with a caveat, and it’s a big one: Do you have someone who loves you enough to give up an organ and is also healthy enough to do it?

The three donors in CPMC’s transplant Friday answer that question with a resounding yes.

Michelle Ratola, a 27-year-old mother giving up her kidney so her mother-in-law doesn’t have to go on dialysis yet; John Williams, who agreed to part with his 65-year-old organ on behalf of a family friend, and Denise Anderson, who got the news on her 14th wedding anniversary that there will be more happy years to come.

Live donations come in two forms — swaps, like the CPMC’s program, and chain donations, the more common procedure, in which one donation sets off a series of donations across the country.

Chain surgeries set up through a national registry — the registry includes 200 pairs and CPMC participates in one almost once a month — but with patients spread out across the country, there is also more room for the chain to break.

Comparatively, CPMC’s swap database includes about 80 pairs. Friday’s three-way swap was only the second involving more than four people at the hospital this year. In April, doctors did a five-way swap.

Friday, everything went according to plan. After 2½ hours of surgery Anderson, Ratola and Williams each woke up with one less kidney and one life saved.

Kidney transplants

90,504 People on the national wait list for a kidney transplant
16,899 Kidney transplants in 2010
6,277 Live donor transplants in 2010
10,622 Deceased donor transplants in 2010

Source: Organ Procurement and Transplantation Network

The patients

Name: John Williams
Age: 65
Residence: Redding
Donation for: Friend

They’re friends, but not attached at the hip or anything.

John Williams just figured since he had an extra kidney and a friend who needed one, he’d be a fool not to help out.

“I actually kind of volunteered the kidney before I thought about it all that much, then immediately after I had the chance to think about it I thought, ‘What the hell did you do?’” Williams said.

Williams’ knee-jerk reaction came from thinking about his wife’s friend, who had two kidney transplants, and how miserable that was.

Williams didn’t want that for Jim Gironda. The two don’t go hunting or out on the town together, but Williams has known Gironda for about 25 years.

After reading more about the procedure, Williams felt good about his decision.

“All the information I’ve gotten says you have an extra kidney, that’s pretty much it,” Williams said.

Name: Denise Anderson
Age: 50
Residence: Modesto
Donating for: Husband

The doctor’s phone call was an anniversary gift Denise Anderson wasn’t expecting.

It was Oct. 11, Denise’s 14th wedding anniversary with her husband, Dale, when they got word Dale may be able to get a kidney transplant.

“We didn’t want to get our hopes up too much,” Denise Anderson said. The two had been let down once already — over the summer the same doctors found a swap match, but it fell through.

But once the surgery was confirmed and a date set, they were ecstatic, Anderson said.

He had been coping with kidney disease for 12 years and, in January, his health had gotten so bad doctors put him on dialysis.

The donors and recipients won’t get to meet unless all agree to it, but Anderson said she’d like to thank her husband’s donor in person.

“It’s really something,” Anderson said. “You’re giving the gift of life; you’re giving something not everyone can give.”

Name: Michelle Ratola
Age: 27
Residence: Daly City
Donating for: Mother-in-law

Not everyone would be willing to give up an organ for their mother-in-law, but Michelle Ratola isn’t everyone.

“As soon as I found out I could do it I was on board,” Ratola said. “It was a very easy decision.”

Ratola and her mother-in law, Maria Calagui, are inseparable.

“I see her every single day — we do everything together,”  Ratola said. “We even do our laundry together.”

When none of Calagui’s four sons was a match, Ratola agreed to be the donor.

Since then, everything has moved quickly.

About a week after finding out she and Calagui weren’t a match, the doctors called back to say they’d found a swap option.

Three weeks after that, Ratola was in the operating room. Her husband and parents were worried, but Ratola had no doubts.

“I just want to make sure she lives for a really, really long time,” she said.

Three-way transplant a complex, involved procedure

Nine doctors, six patients, three operating rooms and one goal: save three lives.

At California Pacific Medical Center, the three-way kidney transplant is an uncommon procedure and one that requires careful planning, according to Dr. William Bry, the Surgical Director of the transplant team.

The doctors run through their roles — each surgeon follows one kidney from origin to end.

They color code all their equipment, right down to the coolers that will carry the kidneys.

Over the course of a month they run numerous tests on their patients to make sure everyone is healthy for surgery day.

It’s a complicated process, but it’s worth it, Bry said.

“Up until 10 years ago, if someone had an incompatible donor we just told them they were out of luck and they had to get on the waiting list and wait for a donor to come up,” Bry said.

Bry has been doing kidney transplants since 1986, and the procedure has changed a lot since then.

Donors used to leave his operating room with a 9-inch incision in their lower abdomen and months of recovery ahead.

Now, he can make three, centimeter-long incisions — two for instruments to separate the kidney and one for a camera to show the way — plus one three-inch cut to remove the fist-sized organ.

Six hours later and all six patients will be resting comfortably with a new combination of kidneys.

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