It all started when a Virginia man read his church bulletin one Sunday. A woman from his parish, someone he had never met, needed a kidney. Thomas F. Koontz, grateful that God had recently saved his teenage daughter from brain cancer, offered her one of his.

When the woman found a more suitable donor, the 54-year-old retired Marine called Johns Hopkins Hospital. Was there someone else, he wondered, who might need his kidney?

Koontz's selfless act started a chain of events that would allow not just one person to get a desperately needed kidney but eight people to get new organs to keep them alive and thriving.

Surgeons at Johns Hopkins Hospital held a news conference Tuesday to announce that they - along with doctors at hospitals in Oklahoma City, St. Louis and Detroit - had just completed an eight-way, multi-hospital, domino kidney transplant. In addition to Koontz, this record-setting swap involved seven pairs of people - each made up of one person in need of a kidney and one willing to donate to them, but whose blood or tissue type was incompatible.

A computer program was fed all of the potential donor pairs and devised a complicated exchange that took place over the past three weeks, with several kidneys being flown around the country. At the end of the line was a woman whose kidneys were weeks from shutting down but had no donor; she completed the puzzle when she received her kidney at Hopkins Monday night. She was the ultimate recipient of Koontz's largesse.

"At the end of the chain, that kidney still goes to someone in great need," said Dr. Robert Montgomery, who led the transplant team at Hopkins. "But along the way, you're able to accomplish two, three, four, eight transplants. ...

"These are all ways of trying to optimize the number of people who are able to receive life-saving transplants."

Hopkins has been performing domino kidney transplants since 2001 and surgeons have kept increasing the number of beneficiaries, with three hospitals and six kidney donations involved in a February procedure.

But officials insist they don't add more patients to the mix for the sake of setting records. Doing it this way allows incompatible but willing donors to secure organs for their friends or loved ones. And the more people involved, Montgomery said, the more people who benefit from a single kidney donation.

He said he hopes that more transplant centers will be willing to engage in these domino transplants, to maximize the number of transplants that can be made possible by one altruistic donor.

In the past, donors in these situations have been asked to travel at their own expense to the hospital where the recipient was located. Montgomery prefers the kidneys themselves do the flying. The biggest limitation in the number of transplants being done, he said, is that there simply aren't enough kidneys to go around. More than 100,000 people are on waiting lists for kidneys. Live donors are preferable to donations of kidneys from the deceased because their kidneys last longer and tend to work better right from the start.

"A transplant surgeon can maybe do 2,000 surgeries in a lifetime," he said. "The work that we're doing here will be responsible for thousands and thousands of transplants.

"What could be better?"

The first transplant in this chain took place on June 15, when Koontz's kidney went to 52-year-old Kathleen Wolstenholme at Hopkins. The next day, Wolstenholme's sister, Theresa Watson, 53, gave her kidney to Robert Brinkmann, a 58-year-old Rockville attorney. Meanwhile, his wife Lisa's kidney was flown to Detroit's Henry Ford Hospital, where it was implanted into 57-year-old Daniel Bruce.

On the third day of transplants - June 22 - kidneys crisscrossed the country, sent among Hopkins, Henry Ford, Barnes Jewish Hospital in St. Louis and INTEGRIS Baptist Medical Center in Oklahoma City, Okla. The kidney donated by Pamela Paulk, a Hopkins executive who was the subject of an article in The Baltimore Sun last week, went to a recipient in St. Louis. In exchange, her co-worker Robert Imes received a kidney from Oklahoma City.

All of the recipients are expected to make full recoveries.Robert Brinkmann was diagnosed with kidney disease two years ago, and it became clear in the last several months that he would need a transplant. For six months he had spent three days a week, four hours at a time hooked up to a dialysis machine. Even on dialysis he didn't feel quite right, often fatigued or queasy. His new wife, Lisa, offered her kidney without hesitation.

"It was totally a selfish reason on my part," she said. "I wanted my husband back."

Their surgeries took place on June 16. They will celebrate their first anniversary on July 19.

"There's a gratitude that's hard to describe," he said.

Koontz, whose donation was the first domino to fall, is humble about his role in all of this. The Fredericksburg, Va., man said by phone Tuesday that he is simply happy that his daughter Sage is doing so well, that Wolstenholme was able to get the kidney she needed and that her mother was so thankful for his gift, and that he should be healed enough by next week to go running again.

"God helped me, so I was trying to give something back to God," he said. "You only need one kidney."

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