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THE WEEKEND AUSTRALIAN 05-04-2009
Chain of goodwill saves lives of kidneypatients
A radical approach tot kidney transplants is set tot slash millions from theAustralian national health bill, writes
Amanda O’Brien
Scores of sick Australian kidneypatiens could potentially be freed sooner from theirdependence on dialysis machines during the next few years, as a groundbreaking Perthtransplant trial prepares to go national.
A trio of kidney recipients recently plucked from the misery of the
five-year transplantqueue
in Western Australia is living proof of what is possible.The men aged 49, 50, and 65, are the first kidney recipients in Australian to benefit from a“domino chain” of three linked transplants from three living donors.It was made possible by
WA’s revolutionary Paired Kidney Exchange,
which proceedsfrom a situation in which people waiting for a friend or relative prepared to donate a kidney.Instead of sending the friend away, the exchange swaps them with a donor from another incompatible couple, to allow
cross-donation
 between the two couples.The WA trial has already gone further by archieving an Australian-first three-way dominochain of transplants.It started with an altruistic stranger who offered to donate a kidney to someone in need. A 65-year-old man was the recipient. His wife then donated one of her kidneys to another man onthe paired exchange, and his wife did the same for another man.The chain ended there only because the third recipient did not have a partner able to donate akidney, but potentially it could go much further.Program director Paolo Ferrari says the possibilies are considerable. “We’re only limited bythe number of couples in the exchange and when we go national that will expand,” he says.Matthew and Julie Clements have nothing but praise for Ferrari, whom they call “St Paolo”.Matthew Clements, 50, spent almost a year on dialysis. For five hours a day, three days aweek, he was chained to a machine. His engineering consultancy business suffered; his sociallife crashed; he was tired, grumpy and always thirsty because of the brutal fluid intakerestrictions associated with dialysis. Julie Clements offered to give him a kidney and wasdevastated to learn she was not a match.But now Matthew Clements is fighting fit an even talking about taking a holiday, somethingunimaginable under his regimented life on dialysis.Julie Clements, a succesful artist under her maiden name, Julie Podstolski, can’t stop smiling.She says her confidence has soared.“I used to be angry, resentful. I felt I had no control. Now I just think: Wow, I did that” shesays.She was the third donor in the Perth domino chain, her husband the second recipient. Thetransplants were carried out in November but revealed only recently ensure everything hadgone well. Ferrari says the benefits go fat beyond Matthew Clements and the other men whoreceived kidneys from the domino chain.1
 
THE WEEKEND AUSTRALIAN 05-04-2009
Everyone on the
waiting list
won because the use of living donors meant fewer people wereleft in the queue for scare organs deceased donors.Ferrari admits the exchange system is not perfect. Not everyone who wants to donate a kidneyis suitable and there are risks.“The first thing that we tell any potential living donor is they have a three out of 10,000chance of dying,”he says. “
Surgery is always a risk.”
There is also the prospect of pain, possibly persisting for weeks, Surgery-related wound infections and localised haematomas.“One in 20 may have a small degree of wound infection,although that can usually treated withantibiotics as an outpatient,” Ferrari says.Most important, donors need to be healthy. Serious illnesses such as heart disease or cancers,even when in remission, will usually rule people out. Diabetes – a main cause of kidneydisease – means a would-be donor is automatically barred.Even when a match is confirmed, Ferrari says, recipients face a 5 per cent chance of rejectingtheir new kidney in the first year and ending up back on dialysis, There is also an increasedrisk of developing cancer due to the immuno-suppressant drugs they must take for the rest of their lives, although those cancers are usually non-fatal skin cancers.Ferrari predicts kidney transplants will increase by up to 10 per cent, or an extra 50 to 60 people, as more live donors are used when the paired program goes national.“It doesn’t sound much but it’s actually a lot,” he says . “By taking 7 to 10 per cent of patientsoff the deceased donor list, those [ who] remain will reduce their waiting time at least sixmonths.
We know that the longer you wait for a kidney the higher is the chance of not surviving.”
The savings also will be substantial. Inhospital dialysis costs more than $80,000 a year a patien. This compares with transplant costs of about $50,000 in the first year and less than$20,000 in subsequent years. He estimates that if 100 pairs enrolled nationally and 30transplants were done anually, the savings from avoiding dialysis would be about $3.5million. ( = € 1,9 million, index: 1 Australian dollar = € 0,5517)Ferrari says people with end-stage kidney disease have contacted him from across Australiaoffering tot move to Perth to participate in his program. But he hopes it won’t be necessaryafter Keven Rudd’s recently created
Australian Organ and Tissue Donation anTransplantation Authority
confirmed the start date for national expansion was likely to beJuly 1.“We have to go national because the chance of finding a match in a paired exchange programincreases as more couples take part.” Ferrari says.“We only have 14 pairs in the West Australian exchange program and with that number thechance of finding a match is about 10 per cent. If we have 50 pairs the chance is about 50 per cent.”The new organ donation authority’s chief executive Karen Murphy says it is hoped some paired exchanges can happen quickly in other states once the number of pairs build up.“Paired kidney exchange is a complex process that requires robust and ethical management, but the aim is for a commencement date of July 1 or earlier if possible, pending key staff appointments,” she says.
Since the West Australian trial began in late 2007, nine patients have had successfullytransplants through the paired exchange.
Six were through two-way exchanges, while theothers were in the three-way chain.2
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