Altruistic donor triggers first transpacific paired kidney exchange

April 13th, 2017
Members of the UCHealth University of Colorado Hospital side of the Colorado-Hawaii paired-kidney donation chain are shown - transplant surgeons Thomas Bak, MD, who did the donor surgery, and Kendra Conzen, MD, who performed the recipient surgery; Jennifer Lee; Maryam Ornelas; Ryan Davis and Jim Fredrick. Lee and Fredrick were donors; Ornelas and Davis recipients.
The UCHealth University of Colorado Hospital side of the Colorado-Hawaii paired-kidney donation chain: from left, transplant surgeons Thomas Bak, MD, who did the donor surgery, and Kendra Conzen, MD, who performed the recipient surgery; Jennifer Lee; Maryam Ornelas; Ryan Davis and Jim Fredrick. Lee and Fredrick were donors; Ornelas and Davis recipients. Fredrick’s kidney went to Ornelas; Lee’s kidney went to Cherish Matauria in Hawaii; and Davis received a kidney from Hawaiian donor Elizabeth Lehman to complete the virtuous circle that Frederick’s altruistic donation started.

It started with a podcast.

It ended with three live-donor kidney transplants among complete strangers, two of them involving the flight of vital organs halfway across the Pacific Ocean – a first.

On the first day of spring, the six people involved were together for the first time, live and via videoconference. Four were at UCHealth University of Colorado Hospital; the other two were 3,300 miles away, at the Queen’s Medical Center in Honolulu, Hawaii.

Jim Fredrick, 54, listened to the podcast in June 2015. The Colorado Springs man tuned in to a Freakonomics Radio episode focusing on problems money alone can’t solve, with organ transplant being a central example.

“I got intrigued,” Fredrick said.

Then in February 2016, Fredrick caught another Freakonomics Radio podcast. It featured a Connecticut man who had listened to that same June 2015 podcast and then donated a kidney to a complete stranger – an altruistic kidney donation, it’s called.

“When I listened to that one, it hit me like a ton of bricks,” Fredrick recalled. “And I said, ‘I think I can do that.’”

He reached out to the UCHealth University of Colorado Hospital Transplant Center. Angela Miskolci, RN, a transplant coordinator, took the case. Of the roughly 140 kidney transplants the UCH Transplant Center did in the past year,  three involved altruistic donors. Thanks to something called paired kidney exchange, those donors can save more than a single life, triggering a cascade of beneficence that works like this.

The big swap

The altruistic donor offers to give her kidney to anyone whose physical dimensions, blood type, age and immune system will allow it. The nonprofit National Kidney Registry takes that information and taps into its paired kidney donation database. The database contains pairs of people. One of them needs a kidney transplant. The other would like to donate a kidney to the first person – but can’t do it because she’s not a compatible donor. So the healthy person agrees to donate a kidney to someone she doesn’t know in exchange for their friend or loved one’s receiving a kidney from someone he doesn’t know.

Why do all this juggling? As of late March, nearly 98,000 people were on the national waiting list for a kidney, according to the Organ Procurement and Transplantation Network (OPTN). They wait, on average, four to seven years. That’s a long wait for anything, and longer yet when one must endure four-hour dialysis sessions three times a week the entire time. Kidney transplant patients who can arrange for a live donor can avoid the virtual line. That’s also the case with paired donors.

But often, it takes someone like Jim Fredrick to set things in motion. And in this case, that chain stretched from Aurora to Honolulu.

University of Colorado Hospital kidney donors, recipients, and Transplant Center staff and surgeons are shown in a teleconference with the Hawaiian side of the trans-Pacific paired donation.
University of Colorado Hospital kidney donors, recipients, and Transplant Center staff and surgeons in teleconference with the Hawaiian side of the trans-Pacific paired donation on Monday, March 20, 2017.

Pair up

Fredrick’s kidney was a match for Maryam Ornelas, 50, of Aurora. She had been diagnosed with cancer in 2014, and the cancer had ruined her kidneys. She had been on dialysis ever since. Jennifer Lee, also of Aurora, volunteered as a paired donor. Lee, 44, said she would have preferred to give a kidney to Ornelas, but they were incompatible. When approached about paired donations, she said, she accepted because “not only could I help her, I could help someone else.”

Theirs was not your typical organ donor-recipient relationship in another way.

“This is my husband’s ex-wife,” Lee told those gathered for the videoconference. “So that’s a little unique twist there.” They’ve been friends for a decade, Lee continued, “and she has graciously allowed me to co-raise my stepdaughter for the last 22 years.”

The Colorado connection of the Colorado-Hawaii paired-kidney donation group is pictured - Jennifer Lee, Mayam Ornales, Ryan Davis and Jim Fredrick. Lee and Fredrick were donors; Ornales and Davis recipients.
The Colorado connection of the Colorado-Hawaii paired-kidney donation group: from left, Jennifer Lee, Mayam Ornales, Ryan Davis and Jim Fredrick. Lee and Fredrick were donors; Ornales and Davis recipients. Fredrick’s kidney went to Ornales; Lee’s kidney went to Cherish Matauria in Hawaii; and Davis received a kidney from Hawaiian donor Elizabeth Lehman to complete the virtuous circle that Frederick’s altruistic donation started.

Lee turned out to be a match for Cherish Matauria, 24, a mother of three young children in Honolulu.

Matauria was already on dialysis in 2015 when Elizabeth Lehman, a nurse at the Honolulu pediatrics office where Matauria takes her kids, “saw how hard it was to manage her kids and dialysis and full-time work,” Lehman said.

Matauria wasn’t quite sure what to make of it at first.

“Out of the blue she texted me one day and said, ‘I want to donate my kidney to you,’” Matauria said. “I thought she was joking but it turns out she really did want to help.”

Lehman and Matauria were also incompatible, but Lehman’s kidney was a match for Ryan Davis, 37, of Elizabeth, Colo. A martial arts instructor with two girls and a boy now ages 10, eight and four, Davis’s combination of diabetes and complications from foot surgery led to kidney failure, he said.

“I was doing dialysis three nights a week, I was working three jobs and trying to homeschool three kids,” Davis recalled. “I had promised my wife I would walk my girls down the aisle. I wasn’t allowed to pass before them.”

Lots of prep

And so the stage was set. What remained was a great deal of preparing and arranging at sea level and a mile above it. In the two weeks prior to the transplant, Miskolci and Maile Reddy, her Queen’s Medical Center counterpart, communicated “sometimes 10 times a day,” Miskolci said. Being part of National Kidney Registry made things easier. This paired exchange program, the largest in the country, matches incompatible pairs and sends out offers for exchanges. They put transplant coordinators in touch with each other and handled the details related to the Denver-Honolulu and Honolulu-Denver transportation. Kidneys fly commercial, and in this case, it was important they had direct flights – they must be transplanted within 24 hours of removal, and the sooner the better. United Airlines’ nonstop from Denver to Honolulu takes seven-and-a-half hours, with the reverse about an hour shorter, thanks to the jet stream. A backup flight with one stop was arranged just in case.

“This was unique in the simple fact that it was going across the ocean so we had to make sure we made our flights,” Miskolci said.

The team at UCH also lined up the transplant surgeons: Thomas Bak, MD, would do the surgeries on the Colorado donors Fredrick and Lee; Kendra Conzen, MD, would transplant the kidneys into Ornelas and Davis.

On Nov. 14, 2016, they did the UCH in-house surgeries, transplanting Fredrick’s kidney into Ornelas. The next day, Bak removed Lee’s kidney in time for a midday flight; it arrived in time for Matauria’s procedure, which started at 5 p.m. in Honolulu. Edwards’ kidney, having been removed four hours earlier, was already en route to Colorado, where, at 6 a.m. on Nov. 16, Conzen transplanted it into Davis, completing the swap.

New lives

The UCHealth University of Colorado Hospital side of the Colorado-Hawaii paired-kidney donation chain are pictured - transplant surgeons Thomas Bak, MD, and Kendra Conzen, MD; Jennifer Lee; Maryam Ornelas; Ryan Davis and Jim Frederick. Lee and Frederick were donors; Ornelas and Davis recipients.
The UCHealth University of Colorado Hospital side of the Colorado-Hawaii paired-kidney donation chain: from left, transplant surgeons Thomas Bak, MD, who did the donor surgery, and Kendra Conzen, MD, who performed the recipient surgery; Jennifer Lee; Maryam Ornelas; Ryan Davis and Jim Frederick. Lee and Frederick were donors; Ornelas and Davis recipients. Frederick’s kidney went to Ornelas; Lee’s kidney went to Cherish Matauria in Hawaii; and Davis received a kidney from Hawaiian donor Elizabeth Lehman to complete the virtuous circle that Frederick’s altruistic donation started.

Four months later, as they convened physical and virtually, they were all doing well. They told their stories briefly. The prevailing vibe was a mix of nervousness, gratitude and amazement. University of Colorado surgeons Bak and Conzen sat in, too, though, as Bak put it, “We just take ‘em out and put ‘em in – these guys are the stories.”

“I just appreciate everyone in this chain and hope it continues to raise awareness about paired exchange,” Conzen said. “Thank you to all of you.”

Asked what their worries had been, the paired donors Lee and Lehman said their primary concern that Ornelas and Matauria would reject the new kidneys.

“And of course I’d be lying if I said I wasn’t afraid to give up an organ and what that meant,” Lee said. “But I think all of the questions I had throughout the process were answered, and my fears were put to rest along the way.”

For the recipients, it’s been life-changing.

“I feel much better – just not having to do dialysis,” Ornelas said.

“Now I can focus on the things that are really important,” Davis said. “And that’s such a blessing I can’t even define it.”

“Whenever I went to dialysis, my kids would always cry and ask me to stay home with them,” Matauria said, her voice breaking. “And now that I have a new kidney, it gives me more time to be with them and watch them grow.”

Fredrick, who set it all in motion with his altruistic donation, said he was back climbing the Manitou Incline three weeks after the surgery. The incision’s healing still kept him from doing sit-ups and such, he said, but he had changed his diet before the surgery, had lost seven pounds and felt better than ever.

“And you recognize you’re just a happier person when you’ve donated an organ voluntarily,” he added. “Most people think: ‘What?’ They don’t get it. Which is fine – I don’t need anybody else to get it. People that do it get it.”

April is Donor Awareness month. For more information on altruistic kidney donation, visit UCHealthLivingDonor.org or call 720-848-0855

About the author

Since 2008, Todd Neff has written hundreds of stories for University of Colorado Hospital and UCHealth. He covered science and the environment for the Daily Camera in Boulder, Colorado, and has taught narrative nonfiction at the University of Colorado. He was a 2007-2008 Ted Scripps Fellowship recipient in Environmental Journalism at CU.

His latest book, "The Laser That’s Changing the World," tells the story of the inventors and innovators who saw, and ultimately realized, the potential of lidar to help solve problems ranging from smokestack-pollution detection, ice-sheet mapping, disaster recovery, and, ultimately, autonomous-vehicle guidance, among many other uses. His first book, "From Jars to the Stars," recounts how Ball Aerospace evolved from an Indiana jar company - and a group of students in a University of Colorado basement - to an organization that managed to blast a sizable crater in the comet 9P/Tempel 1. "Jars" won the Colorado Book Award for History in 2012.

Todd graduated with a business degree from the University of Michigan, where he played soccer, and with a master’s degree from the Fletcher School of Law and Diplomacy at Tufts University. Before becoming a journalist at the turn of the millennium, he was an IT and strategy consultant. He once spoke fluent Japanese and still speaks fluent German.

When not writing, he spends time with teenage daughters and wife Carol, plays soccer, and allows himself to be bullied by a puggle he outweighs by a factor of seven.