Chain Boosts SF Kidney Transplants

Two San Francisco hospitals collaborated to create an elaborate “chain” of organ donors last week, resulting in nine separate kidney transplants being performed between the facilities in a 36-hour period.

The surgeries were performed at UC San Francisco Medical Center and California Pacific Medical Center on June 4 and 5, officials for the two hospitals said earlier this week, with 18 surgeries being performed to accommodate the nine donors and recipients. California Pacific performed 10 procedures; UCSF, eight.

The chain is believed to be the largest to occur within a single city in such a short period of time, according to officials. 

“This ambitious and lifesaving partnership between UCSF Medical Center and California Pacific Medical Center is a testament to the cooperation that happens in San Francisco’s health sector,” said Barbara Garcia, director of the San Francisco Department of Public Health.

The large majority of kidneys available from transplant come from deceased donors, even though clinical data show that organs donated from live patients leads to better outcomes. That has put more pressure on the healthcare sector to try and match live donors with patients. In many cases family members with to donate kidneys to relatives, but they are not compatible.

That so many surgeries occurred at once is part of a new approach toward transplantation services: The use of sophisticated software that drills down through the data available regarding potential donors and recipients and matches them based on compatibility. A transplant chain discards the traditional linkage of a patient on a transplant list waiting for a donation from a specific person. 

Such chains are often launched by an “alruistic” donor – someone who is willing to donate a kidney to anyone, which was the case with the San Francisco chain. The two hospitals used a software application called Silverstone Solutions’ Matchmaker, which was launched in 2007. It was developed by David Jacobs, who underwent three years of dialysis before finally receiving a kidney from his neighbor in a transplant that occurred at California Pacific. The ordeal inspired him to create the software.

Although some chains can involve as many as 30 donors and recipients apiece, chains occur over a wide geographical area with patients and donors ferried to hospitals throughout the United States to complete the process. UCSF and California Pacific are less than two miles from one another, and the  large majority of the patients in the chain came from Northern California. The two hospitals collaborated on a six-patient chain earlier this year and will continue to work together to try and complete transplants that cut down on patient travel.

“This collaboration with California Pacific Medical Center enables us to broaden our pool of kidney transplant donors and recipients and treat them at two medical centers separated by only a few miles,” said John Roberts, M.D., chief of the UCSF Medical Center Transplant Service. “The proximity of the hospitals means the donated kidney can be swiftly transplanted, minimizing risks to patients. This paired kidney exchange also benefits those on the transplant waiting list and moves up others who are still waiting.”

Despite the success of these transplant chains, the U.S. still faces a daunting task in matching patients who need organs with donors. About 17,000 transplants are performed nationwide every year, but there are still more than 100,000 Americans who need organs. The average wait to receive one is eight years.

There are more than 18,000 patients on waiting lists in California and nearly 7,200 on waiting lists between UCSF and California Pacific. The UCSF waiting list of 5,258 is the largest in the country. 

A recent study in the Journal of the American Medical Association concluded that “nearly all state-level policies to encourage organ donation have had no observable effect on the rate of organ donation and transplantation in the United States.” The only policy that appeared to work – allowing residents to donate to state-operated funds that promoted organ donations – bumped up the number of organ transplants per state by about 15 per year.