Kidney exchange between strangers spans continents

Written by Alex Crees

Two strangers living across the world from each other in the U.S. and Greece made medical history when they became the first to donate their kidneys in an intercontinental paired exchange, according to a press conference Friday at the Greek Embassy in Washington, DC.

Oklahoma resident Elizabeth Gay donated one of her kidneys to a Greek man living in Athens. In return, the man’s wife Theodora Papaioannou-Helmis donated her kidney to a man living in Pennsylvania.

These initial exchanges have sparked a donor chain that has so far saved the lives of four Americans and one Greek resident, with three more transplants scheduled in the coming weeks. In the upcoming transplants, a donor from Trinidad and Tobago will enter the chain as well.

The donor chain process, known as kidney paired donation (KPD), happens when a donor who is incompatible with a designated recipient agrees to donate his or her kidney to a stranger, in order for the designated recipient to receive a kidney from another stranger.

This international chain was made possible through the American organization Alliance for Paired Donation (APD), which set up the exchanges, and the efforts of Papaioannou-Helmis, who campaigned to change Greek transplant laws in order to help find her husband Michelis a kidney.

Changing Greek law

Previously, Greek law—similar to laws in other European countries and South America—stated that only a first or second degree relative could legally donate a kidney to a recipient in the country. The law was put into place to limit black market organ harvesting and selling.

However, it also restricted the process of paired donation, which essentially requires strangers to ‘swap’ kidneys.

After the law was lifted in Greece, as well as in other countries such as the U.K., Italy and Spain, Helmis and her husband became the first international members entered into the APD’s recipient and donor pool, and thus were able to open up their search—which eventually ended across the world with 31-year-old Gay.

“This is something I can remember I wanted to do when I was a kid,” Gay said, regarding her unsolicited choice to donate, “I must have had a good kindergarten teacher who taught me how to share. I’ve just always felt like, if I have two good kidneys, why would I not share?”

Most paired donations are between designated donors, but sometimes they are started or facilitated by an altruistic donor, such as Gay, who did not have a friend or relative who needed a kidney, according to Dr. Michael Rees, Director of Transplantation at the University of Toledo Medical Center and CEO of the APD.

“Elizabeth just came forward and said, ‘I want to love a stranger. I don’t care who that is—you guys figure that out,’” Rees explained. “Every time before this, the donations were made to someone else in America, but this time the computer found Michelis in Greece, which made [Gay’s] donation unique.”

A kink in the chain

As part of the exchange, Papaioannou-Helmis was then matched with a recipient in Georgia, who would in turn donate to a person in Oregon. However, just before the surgeries were scheduled to happen, the Georgia recipient became ill and unable to undergo transplant surgery. There were no other potential recipients Papaioannou-Helmis was a match for.

According to Rees, this left the doctors with two choices: either drop the chain and simply allow Gay to donate to Papaioannou-Helmis’ husband, or trust Papaioannou-Helmis to step back into the chain when a match was found in the future.

The major roadblock in this case, Rees said, was that the U.S. has a prohibitive law that only allows kidney donors to have their kidneys removed at a U.S. transplant center. Like the former Greek law, it is also meant to limit the possibility of black market trades.

The law meant that doctors would have to allow Papaioannou-Helmis to fly back to Greece after the surgery and then trust her to return to America, on her own dime, when they found another match for her.

“There are no transplant centers approved internationally, so it’s impossible to ship organs from Greece or elsewhere,” Rees said. “…We need to change that law.”

So much was at stake, according to Rees, he almost called the entire chain off. As the part of the first intercontinental exchange, if Papaioannou-Helmis didn’t return to the U.S., it could seriously set back the credibility and establishment of an international paired exchange system.

In order to make a decision, Rees consulted with Dr. Dimitris Moutzouris, the nephrologist who treated Papaioannou-Helmis’ husband.

“First of all, it’s really difficult to get someone to guarantee something like that,” Moutzouris said, “But I’ve been taking care of her husband for so long. This woman—it took so much strength to do what she had done. I was pretty sure she wouldn’t let us down.”

Paying it forward

Sure enough, when a match was found months later in Wilkes-Barre, Penn., Moutzouris judgment proved correct: Papaioannou-Helmis flew back to the U.S. to donate one of her kidneys to 58-year-old Charles Ripple.

Ripple had no reservations about an international exchange.

“I was just so happy, I didn’t know if I’d ever get one,” he said. “…Someone called me on February 28 to let me know—the same day I got my first kidney in 1991. I just knew it had to work.”

The next transplant surgeries in the chain will take place in Atlanta, Ga., and Denver, Colo., and involve a donor from Trinidad and Tobago in the Caribbean.

“This is important because the bigger the pool, the more people you can transplant,” Rees said. “An international pool is bigger than anything you could create in one country.”

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