One kidney, three bodies, in two weeks: World's first 'hand-me-down' kidney transplant saves father-of-five, 67, after brother's body rejects sister's organKidney donated by Cera Fearing, 21 to her brother Ray, 27After Ray's body rejected transplant, kidney was given to 67-year-old Erwin Gomez, a surgeon and father of fiveFirst documented double transplant of kidney on record
08:09 GMT, 26 April 2012
Hand-me-downs work with unwanted or unsavory clothes, as they apparently do with organs.
One kidney has made its way to three people in two weeks, in what looks to be a medical first.
The kidney in question was donated by 21-year-old Cera Fearing, who originally donated the organ to her brother Ray, 27, who suffers from a common form of kidney disease.
When Mr Fearing’s body rejected the transplant, he chose to pass on the kidney to someone else who could use it. And so, 67-year-old Erwin Gomez, a surgeon and father of five, was the final recipient of Ms Fearing’s kidney.
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Line of progression: Cera Fearing, right, donated her kidney to brother, Ray, centre; the kidney then went to Erwin Gomez, left, after Ray's body rejected the transplant
The miraculous story of the Chicago-area transplant is detailed in Thursday's issue of the New England Journal of Medicine.
There have been other cases since the 1980s of transplant organs being used more than once, but they were rare and involved instances in which the first recipient died.
Typically when transplanted organs fail in living patients, doctors throw them away. But with more than 73,000 people awaiting transplants nationwide, some specialists say doctors should consider trying to reuse more organs to ease the severe shortage.
'The need for kidney transplantation doesn't match our capacity,' said Dr Lorenzo Gallon, a Northwestern University transplant specialist who oversaw the kidney recycling operation in Chicago.
'People die on dialysis' while awaiting kidneys.
That was the possible fate awaiting two strangers. A research letter describing the unusual case was published in Thursday's New England Journal of Medicine.
The donated kidney lasted just two weeks in Mr Fearing. The same disease that ruined his kidneys started to damage the new kidney, given to him by his sister.
Sibling love: Cera donated her kidney to her older brother Ray, but his body soon rejected the transplant
He was getting sicker, and doctors needed to act fast if they were going to save the organ. With permission from the man and his sister, they removed it last July and re-transplanted it the Indiana surgeon.
Mr Fearing is back on dialysis and will probably get another transplant eventually.
Still, reusing a transplanted organ can be tricky – and riskier – because surgeons have to deal with scar tissue that typically forms around an organ as the body heals from the operation.
Wayne Shelton, a bioethicist at Albany Medical College in New York, said the practice may raise ethical questions. He said doctors need to make sure patients who are offered reused parts understand all the risks and are not made to feel coerced into accepting such organs.
'I just assumed it's damaged, it's
garbage. The fact that they were able to give it to someone
that somehow was able to benefit from it was great.'
And because these cases are so rare, there is little data on how patients with recycled parts fare, Shelton noted.
Fearing had a disease that caused scarring that prevented the kidneys from filtering waste from blood. He had to quit his industrial machinery job and went on dialysis a year ago.
His sister donated a kidney last June in what was 'probably the happiest moment of my life,' Fearing said. The worst, he said, was a few days later, when doctors told him the kidney was damaged and had to be removed.
Gallon, medical director of Northwestern's kidney transplant program, thought the kidney could be reused in somebody else if it was removed quickly, before it became irreversibly damaged.
Gallon needed Fearing's permission, and also asked the young man's sister, Cera Fearing.
Clandestine meeting: Dr Lorenzo Gallon, transplant nephrologist and medical director of the kidney transplant program at Northwestern Memorial Hospital, talks with the three in their first meeting
Mr Fearing said he was heartbroken and reluctant to abandon an organ that had been his only hope for a normal life. But he decided it was the only option that made sense. His sister, too, was crushed but said she didn't hesitate when told her kidney might help someone else.
'I just assumed it's damaged, it's garbage,' she said. 'The fact that they were able to give it to someone that somehow was able to benefit from it was great.'
Gomez was selected because he was a good match. But Gallon said doctors also thought Gomez's medical background would help him understand the complexities. Gomez said he had never heard of reusing transplant organs, and he worried about taking what seemed like damaged goods. But he agreed after the Northwestern team explained the risks and possible benefits.
The removal and retransplant operations took place July 1. Within two days, the transplanted kidney had regained function. Gallon said he is convinced the damage is reversed.
Gomez is taking anti-rejection drugs and is off dialysis. 'I finally feel normal,' he said. Fearing is back on dialysis and said he is doing OK.
Gallon said it is not uncommon for patients with Fearing's disease to go through more than one transplanted kidney, and he expects Fearing will eventually get another one.
Despite his own misfortune, Fearing said he is 'extremely happy about being a part of this medical breakthrough' that might end up helping others.
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