Thursday, July 28, 2011

Transplant is perfect match


stuart-kilgannon.png (220×193)
Islander Tim O’Brien has summited Mt. Rainier 99 times. One of those climbs was to marry Cory Mackie. On July 20 this year, the couple celebrated their 10th wedding anniversary just a few days early this year again on the mountain. The marriage has been a good match in more ways than one. Mackie donated one of her kidneys to her ailing husband less than six months ago.
Both O’Brien, 54, and his wife Mackie are by all accounts in excellent physical condition. O’Brien not only hikes and climbs, but plays and referees soccer among other sports. Mackie is a swimmer and runner, and hikes and climbs with her husband. But five years ago, O’Brien began being plagued by an unusual tiredness.
He told his doctor his symptoms during his routine physical and was quickly diagnosed with polycystic kidney disease (PKD). O’Brien, adopted as a child, was unaware of his biological family’s history for the genetic disorder that causes kidney failure. Yet, he was able to manage the disease for nearly five years through diet and exercise, but over time, the condition worsened.
Last year when he climbed the mountain, he was unusually exhausted. The time had come to assess O’Brien for a kidney transplant.
In order to be considered to qualify for a transplant list, PKD patients’ kidney functionality generally must fall to just 20 percent. Dialysis usually begins at a level of 15 percent functionality. Functionality below that level rapidly becomes fatal. Keeping O’Brien’s kidneys functioning in order avoid dialysis, yet be eligible for a transplant, was the goal.
“We were threading the needle,” Mackie said.
Knowing for some time that a transplant was on the horizon, Mackie, 47, suggested to her husband that he consider her as a potential donor. But she thought that she would not be a good enough match.
“From the time Tim was diagnosed until we found out I could be a donor, I had a lot of time to think about this and consider the options,” she said.
“I thought that a ‘paired donation’ or a ‘daisy-chain’ donation might work for us,” she said, referring to when patients and donors come together to work out donor-patient matches.
In November 2010, Tim met with Dr. Andrew Precht at the Swedish Organ Transplant program and underwent the necessary tests to be approved for the organ transplant waiting list.
Precht noted O’Brien’s excellent physical condition and his mountaineering experience. He told the couple of his annual climb of Mt. Rainier to promote organ donation awareness. He said that Tim would be an excellent candidate for both the transplant and the climb.
“We’d better get you going so you can recover in time for the climb this summer,” the doctor said.
“Hearing him talk like that was confirmation that Tim was going to get better,” Mackie remembered.
As they discussed her husband’s treatment, Mackie asked Precht to consider her as a potential donor for Tim.
On the spot, Dr. Precht was able to pull up Mackie’s electronic patient history and confirmed that she was indeed a potential match for her husband because of her O-positive blood type and overall good health.
To increase her chances of being a suitable donor and because she sensed time was growing short, she had a full check-up just the month before, she said.
“Dr. Precht was thrilled,” she said, “to have us both in line for the climb.”
Her husband wasn’t so sure about his wife donating her own healthy kidney. “But she was adamant,” he said.
The decision was made easier for her, Mackie said, because her parents were both medical professionals. He mother, a scrub nurse, took part in early transplant surgeries in Hawaii. Both parents would come home and talk about their work with their two daughters at the dinner table. As a result, Mackie said she was unafraid of what she was getting into.
“It never even fazed me to think about it,” she said. “I am no hero. I just did what anyone would do.”
What was on the mind of both was Tim’s daughter, Claire, who is 15.
“I thought, what it would mean to her,” Mackie said. “I could not think that Claire might not have her father.”
O’Brien said Claire, 15, who attends University Prep in Seattle, was worried. “She was pretty nervous about the transplant,” he said.
“She made a “bucket list” for us,” he said. “She wanted to get a learner’s permit and for us to drive together. She wanted to do some target shooting.”
And they did.
She plays soccer, while her father is a referee, apparently in constant motion. He was a referee for a key regional soccer game the day before the transplant surgery.
The surgery was set for Jan. 31. It was a success. Mackie was released from the hospital in three days and O’Brien was out in four. Waiting to help them recover at home were Mackie’s parents. The entire process took a remarkably short 62 days — a record for the Swedish program.
But more importantly, it saved O’Brien from ever having to undergo dialysis treatment.
“I felt better immediately,” O’Brien said. “Even despite the pain from the surgery itself — I knew something was different. It was a good kidney — it was working right away.”
In less than a month, the couple was back to work and back to their routines. And less than 6 months later, they were back on Mount Rainier.
O’Brien has returned to his workout regimen and  takes immunosuppressants, vitamins and other medications religiously. He considers himself very lucky.
The couple, along with their surgeons and doctors at Swedish, wants to emphasize the importance of registering as an organ donor.
Researchers have long known that a transplant surgery and the long-term care post-transplant is cheaper than having a patient on dialysis — and transplant patients, in particular those from a living donor, have better outcomes and live longer. The cost of a kidney transplant has dropped so significantly that researchers say it is cheaper to have a transplant than to stay on dialysis for more than two and a half years, even among the sickest patients.
The statistics for those with end stage kidney disease and other diseases requiring transplants are sobering.
1. More than 100,000 U.S. patients are currently waiting for an organ transplant; more than 4,000 new patients are added to the waiting list each month.
2. Every day, 18 or more people die while waiting for a transplant of a vital organ, such as a heart, liver, kidney, pancreas, lung or bone marrow.
3. Nearly 10 percent of the patients currently waiting for heart transplants are young people under 18 years of age.

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