The domino effect

The Living Donor Paired Exchange program is helping to increase the number of people who can receive kidney transplants

Jan Collins-Allen donated her kidney so her husband, George Allen, could receive one in exchange
Jan Collins-Allen donated her kidney so her husband, George Allen, could receive one in exchange.
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Transplanting a kidney

What kidneys do

Winnipeg Health Region
Wave, March / April 2014

It all happened suddenly.

For 11 years, George Allen had lived a normal life with his transplanted kidney. Then one morning, around 2 a.m., Allen started to feel ill. Within hours, he was in the Emergency Department at St. Boniface Hospital. Soon after, doctors gave Allen and his wife the news they'd been dreading - his donated kidney had failed and he'd have to go back on dialysis.

Allen knew he faced an uphill battle. Since he'd already had a kidney transplant, his body had formed antibodies that would make it even more difficult for a suitable donor to be found. The kidney from his first transplant was donated by his sister and had been a near-perfect match.

"I talked to the doctors and said I wanted to be a donor for George, but I wasn't a match. We were very disappointed about that," says Jan Collins-Allen, 54, Allen's wife of 29 years. "We had other friends who wanted to step up but they couldn't, due to their own health concerns."

Allen, 57, was diagnosed with IgA nephropathy, the most common form of glomerulonephritis, (inflammation of the glomeruli of the kidney) in 1999. He faced an uncertain future until his physician told him about the Living Donor Paired Exchange (LDPE) program offered through Gift of Life.

The LDPE is a national program that allows incompatible pairs of willing donors and recipients to join others across Canada, moving healthy kidneys forward to people who are a match.

While a person with a malfunctioning kidney may have a willing donor, the two are sometimes incompatible due to differences in blood type, or antibodies that would cause the recipient to reject the donor's kidney. To enrol in the LDPE, Collins-Allen had to agree to donate a kidney to someone else in need. She would only be required to donate if a match was found for her husband.

"The amazing thing is how this program multiplies the kidneys that are available. If someone does the math, they'll understand the implications immediately. It's like going from a onein- ten-million shot to one-in-500,000. It makes that much of a difference," says Allen. "Before this program, you had no exposure to living donors beyond your own little circle of friends and family. This opens up the entire country."

His wife wanted to sign up for the program immediately. It was Allen who took a little more convincing. "I had no issue with where her kidney went, but this was major surgery. We've already got one person with a broken wing - do we want to risk both? I had to weigh what it was going to do for us as a family versus the risk of both surgeries," he explains.

Launched as a three-province pilot project in 2009, the LDPE - which operates as a partnership between Canadian Blood Services and transplant programs across the country - recently passed the 250-transplant mark, with all provinces participating. Not only do these transplants improve and save lives, estimates suggest the net benefit of a transplant over dialysis is approximately $50,000 per patient per year.

Manitoba joined the LDPE in 2010, with the first Manitoban receiving a transplanted kidney through the program in 2011. In total, 13 Manitobans have received kidney transplants since then.

"Two hundred and fifty transplants is a phenomenal success - Canadians should be very proud, says Dr. David Rush, Director of Transplant Manitoba's Adult Kidney Program. "You can have ten transplants done at one time through this program - it has a multiplying effect. If an altruistic donor is part of the chain - those who undertake this surgery out of the goodness of their hearts - another donor is freed up and can donate to someone from the waitlist."

The Allens were accepted into the program in October, 2012. Soon after her round of medical tests - which included blood work, an EKG, and a chest X-Ray - were complete, a match was found for Collins-Allen's kidney. A donor was also found for Allen. Their surgeries were scheduled for the same day in January, 2013.

Collins-Allen was flown to another province for her operation, while her husband remained in Winnipeg for his transplant. "I personally have no trouble with doctors and operations. I had absolute confidence in the whole system," says Collins-Allen. "I just wanted George to get healthy and this was the fastest way to do it. This is what had to be done and I didn't think twice about it."

She was wheeled into the operating room on a Thursday morning. Her kidney was removed by laparoscopic surgery. By Sunday, she was released from the hospital, and returned home on Tuesday. "I don't think I'm a superhero as far as pain goes. Of course, there was some initial discomfort, but the recovery was really easy," Collins-Allen says. "I can barely see the scar. Sometimes I forget I've had it done."

Since the surgery, Collins-Allen has to pay more attention to her blood pressure, which has remained normal, and drink lots of water. Everything else is pretty much the same, says the elementary teacher and mother of two.

"The LDPE is an amazing program. One thing that bothers me is that it's not promoted that much," she says. "No one I've told has ever heard about it. Unless you need it, you don't know it exists."

It's been a year since the transplant without any complications. Allen says it feels like winning the lottery twice. "I feel great. I'm working, I love my job, and we have time together as a family again. We can go to our cottage in the summer," he says. "It's humbling to the extreme. I'm very lucky Jan is who she is." Allen is also grateful to the health-care team that took care of him.

"Seldom does one get the opportunity to publicly thank all the people that provide vital care day in and day out - the nurses, the staff at Health Sciences Centre Winnipeg and the Seven Oaks Dialysis Unit. I especially want to thank Drs. (Martin) Karpinsky and (Leroy) Storsley, as well as Dr. Rush."

By increasing the pool of potential donors, the paired exchange program has helped increase the number of people who are able to get a transplant and reduced the number of people waiting for a match. Nonetheless, there are currently 263 Manitobans on the waiting list for a kidney transplant. That's why the Gift of Life program continues to raise awareness about the importance of becoming a donor. Manitobans who want to learn more about becoming an organ donor can visit for more information.

Holli Moncrieff is a Winnipeg writer.

Wave: March / April 2014

About Wave

Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

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