The Ups and Downs of Kidney Transplantation

Yesterday, when Janet said she would be a donor despite the fact that her blood does not match mine, I was so happy. Janet's willingness to be a paired donor (she gives her kidney to a stranger who also has a mismatched donor, and I receive a kidney from the stranger's donor) gave me so much hope.

Later in the evening, however, I started to think about things a bit differently. O blood type is the universal donor: O can donate to O, A, B, or AB. But O can only receive blood from another O. A can receive from A or O. B can receive from B or O. AB is the universal recipient, as it can receive from A, B, AB, or O. So, basically, if Kidney Patient X has blood type A (Janet's an A) and has an O donor (I'm an O), X would take the kidney from the O donor. In short, X doesn't need me. I need X's donor, as I'm type O, but X doesn't need me. So, I couldn't see a reason why anyone would want to be a paired donor with an O. If an A, B, AB, or O kidney patient has an O donor, why not just use him or her? A trade isn't necessary. This realization certainly sobered my mood.

It just so happened that today I had my monthly dialysis clinic visit. I asked my nephrologist if there would be any reason why an A kidney patient with an O donor would agree to a trade. He said I was right, it's unlikely, but not impossible. The matter of antigens comes into play. Kidney transplantation looks at six antigens in the blood. When donor and recipient match in all six antigens, they're a perfect match. The more matches, the better the long-term viability of the transplanted kidney. But that has changed somewhat in recent years with improved immune suppressants. Even a zero match with a living donor has good prospects. (Actually, having a living donor, rather than a deceased donor, seems to be the biggest advantage in survivability of the recipient and viability of the kidney.) So, if Janet and the type A kidney patient were a six-point match, then there may be an incentive to do a trade. Otherwise, probably not. So, I left Dr. Butman's office a bit bummed.

Later in the afternoon I spoke with Angie, the assistant transplant coordinator. I asked her if Dr. Butman and I were correct in our concerns. She said yes, then added that Kaiser Downey's first paired donor surgery had occurred today at UCLA. I asked about the pairing. She checked her files. The Kaiser patient is an O! Wow, this again gave me hope. If it can happen once, it can happen for me too.