The U.S Justice Department has cleared the way for hospitals nationwide to begin performing what is now a rare transplant operation in which multiple donors give kidneys to unrelated recipients.
The decision is being hailed as a step that will save thousands of people who would otherwise die awaiting new kidneys.
"It's a huge thing," said Dr. Richard B. Freeman, chairman of the legislative committee of the American Society of Transplant Surgeons.
"It's going to make dramatic difference in removing barriers we've all faced trying to perform paired transplants," said Freeman, a surgeon at Tufts-New England Medical Center in Boston.
Johns Hopkins Hospital is one of the few that have been performing transplant operations known as kidney paired donations. Since it pioneered them in 2001, about 140 have been performed nationwide, including more than 40 at Hopkins, said Robert Montgomery, an associate professor of surgery and director of Hopkins' Comprehensive Transplant Center.
"It's going to really create a large number of kidney transplants, nationwide," he said.
Most kidney transplants involve dead donors, but the federal action is expected to lead to a greater number of living donors.
The Justice Department issued a memo Wednesday saying that nothing in federal law prevents someone from donating an organ in exchange for having a relative or loved one receive an organ from someone else.
Officials said the memo would be posted on the department Web site today and declined to comment further.
About half of the 6,000 patients awaiting compatible kidneys will get one because of the ruling, Montgomery said.
Last year, 4,056 kidney patients died while awaiting transplants, according to the United Network for Organ Sharing.
The federal decision should cut the five-year average waiting time, Montgomery and other experts said.
"It really opens the door to ramping up kidney paired exchange programs," said Dr. Stephen Bartlett, a transplant surgeon who is chairman of the department of surgery at the University of Maryland School of Medicine.
The procedure is likely to begin "fairly soon" at University of Maryland Medical Center, said Bartlett, a transplant surgeon who is chief of surgery at the medical center. "It's a big step forward," he said.
Kristine Jantzi, 40, of Bangor, Maine, who received a kidney in a five-way swap, welcomed news of the Justice Department ruling.
"That is such good news," she said. "I'm really hoping this will save a lot of lives."
Jantzi suffered kidney failure when she was a junior in high school. Her mother was willing to donate one of her kidneys, but the two weren't a match. At the time, there was no such thing as a paired match, so Jantzi had to wait until she was 20 for a kidney.
"You really are limited to just your own family and friends," she said. "But there are a lot of people who have other people willing to donate."
After her replacement kidney failed a decade later, Jantzi went on dialysis for 12 years until she joined in the five-way swap performed at Hopkins last November.
The procedure involved five donors and five receipients, and required more than 100 medical staff members working simultaneously.
Advocates for kidney patients say the decision follows years of lobbying in Washington.
"We've been seeking this kind of change for seven or eight years, ever since hospitals started to perform these living paired donation transplants," said William Lawrence, director of patient affairs for the organ-sharing group.
The practice has remained rare because of legal uncertainty resulting from the wording of the 1984 National Organ Transplant Act. The law makes it a crime, punishable by up to five years in prison, to transfer a human organ for "valuable consideration."
The law was intended to prevent people from buying and selling kidneys, which, unlike other organs can remain viable outside the body for up to 24 hours.
"Congress didn't want things to turn into a bidding situation," Lawrence said.
Lawrence and Montgomery said they are optimistic that Congress will pass a bill to specifically permit kidney-paired donations. A federal law would add strength to the legal interpretation covered by the Justice Department memo, they say.
Bills authorizing such donations have passed in the House and Senate, but differences in wording must be worked out, Lawrence said.
Federal auditors estimate that kidney paired donations performed nationwide would save $500 million each year in Medicare costs for dialysis, he said.
Lawrence's Richmond, Va.-based nonprofit, set up more than 20 years ago by transplant surgeons, operates a federally funded registry for organ donors and recipients. The group will begin working on adding a section to its registry for kidney paired donations, Lawrence said.
"Thousands of people are going to get transplants that otherwise may not have gotten transplants," he said.
One might be the wife of David Matthews, a retired State Department employee from Washington who is ready to donate a kidney to a compatible recipient so that she can get one.
"Why the federal government would ever stand in the way is strange to my way of thinking," he said.
For archived coverage of paired kidney donation surgery, go to baltimoresun.com/kidney