A joint kidney registry between Canada and the U.S., as well as better co-operation between Canadian health centres would speed up life-saving matches for patients, says a Calgary-trained doctor who pioneered live donor chains.
Dr. Jeffrey Veale, who graduated from the University of Calgary and now works at UCLA, is one of the first doctors who promoted kidney transplant chains based on the idea of "paying it forward" — that the beneficiary of a good deed will, in turn, do one for someone else.
The chain begins with an altruistic donor who gives a kidney to someone with a relative who wanted to donate but wasn't a match. That relative's kidney is then donated to a stranger in the same situation, and the chain continues for as long as possible.
"Thirty to 40 per cent of people with living willing donors don't match their living donor. We've been basically not utilizing these kidneys," Veale said Thursday in Calgary, where he is receiving an award from his alma mater.
The first chain was created by a doctor in Toledo, Ohio, but Veale spearheaded a program at the UCLA hospital that involved eight patients in its first live donor chain in July.
'The patients aren't the problem. It's about getting centres to work together.' —Dr. Jeffrey Veale
"I wish it was my idea. I mean it seems so straightforward. We should have been doing this for the past 30, 40 years," he said.
Veale called the donor chain a beautiful concept that could have drastic implications for the thousands of people on Canada's kidney waiting list. A successful transplant frees the patient from the need for constant dialysis.
But it will require an attitude shift by Canadian hospitals. Veale said the biggest challenge in organizing the project in California was getting hospitals to put competition aside in order to co-operate.
"The patients aren't the problem," he said. "It's about getting centres to work together."
Hospitals in Toronto, Ottawa and Edmonton have done similar surgeries, where donor-patient pairs exchange organs.
Cross-border registry could cut wait lists
Veale said more matches could be made if a kidney registry were set up between Canada and the United States.
"Maybe a kidney may have to go from Canada to the United States and the United States back to Canada, but if we can transport pencil cases and oranges and cars, I don't see why we couldn't transport life-saving organs," he said.
Earlier this year, Canada launched its first national living donor kidney registry, which aims to connect people who need kidneys and their relatives who are willing to donate but aren't a match with others who are in the same situation. So far, the registry is focusing on exchanges where several donors are matched and transplants done at the same time, called domino transplants.
In the altruistic chains, such as the one led by Veale, transplants can continue for months, picking up new donors along the way.
"The thinking is valid. However, in our opinion, we just aren't ready for that kind of conversation," said Steve Brule, executive director for organ registries at Canadian Blood Services, which runs the registry. "We are still trying to roll this out across Canada … And, given the challenges we are having addressing privacy issues with a national registry, I couldn't imagine the difficulties we would need to tackle for a (cross)-border exchange."
'She gets her life back'
In July, Arturo Carvajal donated his kidney to a patient whose relative wasn't a match, in order for his wife to receive a kidney from someone else in the chain. Three Los Angeles-area patients got kidney transplants through the process.
"Being part of this means she gets her life back, along with other people," Carvajal said on Thursday sitting near his wife's bed as she recovered at the University of California at Los Angeles hospital.
Veale's program at UCLA garnered so much attention that the idea of a donor chain was used recently in the TV medical drama, Grey's Anatomy.
"I didn't see the episode but I think it's wonderful that it's in the mainstream media," Veale said.