Trinis in historic kidney transplants

EREMY Weiser-Warschoff, 13, met Paul Boissiere, a soft spoken 30-year-old electrical engineer from Trinidad, for the first time Saturday, even though they had been linked for the last five days by Jeremy’s newly implanted kidney, which Paul had donated, the New York Times reported. The web of connection had actually been a lot more complicated than that.  In return for Mr Boissiere’s kidney, a friend of Jeremy’s family donated a kidney to Tracey Stahl, a very ill mother of two from Johnston, Pa.  And Mrs Stahl’s sister, Connie Dick of Latrobe, Pa, gave her kidney to Boissiere’s seriously ailing fianc?, Germaine Allum, who is also from Trinidad. The triple-swap kidney transplant operation was announced in a news conference Satur-day at Johns Hop-kins Comprehensive Trans-plant Centre, which said it believed that this was the first time three simultaneous kidney transplants have been performed. Other transplant experts, the New York Times reported, said they had not heard of another three-way exchange in the nation.

Months in the making, the exchange was the only way all three recipients could have received a kidney, the lead surgeon, Dr Robert A Montgomery, said, because of tissue, blood antibody incompatibilities among the donors and their originally designated recipients. Many patients arrived at the Baltimore centre only to discover that a person who is willing to donate a kidney is not suitable, Johns Hopkins has found.  With 55,000 people on the national waiting list for a kidney, the United Network for Organ Sharing said, and only about 25 percent a year likely to get a transplant, John Hopkins said it was trying to explore novel ways of matching organ donors and recipients. Dr Montgomery, who directs the Johns Hopkins incompatible-transplant programme, said the centre has created a “matchmaker system that attempts to pair all of our incompatible donors and recipients.”  A former patient contributed money to cover the salary of a coordinator, who identifies the matches, he said. Of the possibility of death for donors, Dr Stephen T Bartlett of the University of Maryland said: “The risk is about 3 in 10,000. The chances of dying are low, but real and present.”  Other dangers include excess bleeding, blood clots to the lung and missed injuries to the bowel. Mrs Stahl, a 38-year-old waitress, was the centerpiece of the swap that was announced Saturday.  She had been suffering with progressive kidney failure for five years, but she had developed too many harmful antibodies, or blood proteins, from pregnancies and blood transfusions to be a match with her sister, even though they shared the same blood type, B.

Mrs Stahl had five plasmapheresis treatments, where the patient’s blood filtered until free of the antibodies that reject a donor kidney. Even so, when the sisters turned to Johns Hopkins, they found that a kidney donated by Mrs Dick would almost certainly be attacked and destroyed by Mrs Stahl’s antibodies. “But in a stroke of good luck,” Dr Mont-gomery said, Jeremy’s friend, Julia Tower of Hyattsville, Md, had a compatible tissue and blood type for Mrs Stahl. Ms Tower had known Jeremy since childhood, and had become closer to him last fall during a hiking trip with him and his parents, Linda Warschoff and Ellen Weiser of Silver Spring, Md.  At her age, she turned 57 on Thursday, Ms Tower said she thougt carefully about whether she wanted to donate a kidney, then “I told them in March I was willing.” Ms Tower has Type O Blood, the universal donor type, which should have been a good match for Jeremy, whose blood is Type A.  But she was not a good tissue match because similarities with Je-remy’s previous donor, his biological mother, who donated her kidney when he was 17 months old.  
That kidney was failing, and Ms Weiser’s kidney was not compatible because she had once been exposed to Hepatitis B.

That’s where Paul Boissiere stepped in.  His blood, Type A, was incompatible with his fiancee’s Type B blood, but he was willing to donate to a stranger.  When they inquired at Johns Hopkins, Ms Allum, 28, had been hospitalisd for several months in Coral Gables, Fla, and her heart had stopped twice, so they were desperate. The transplant operations which the New York Times said, cost US$92,000 each, were performed last Monday by three surgical teams, who worked from 7 am to 6 pm, Dr Mont-gomery said: “From the time she was diagnosed with kidney problems,” Bois-siere said of Allum, an accountant with the Ernst & Young firm’s branch, “I wanted to give her a kidney.” For her part, Allum, who has dated Boissiere for 13 years, smiled and said her friends had noted: And you don’t even have him tied down.”