Defense Department charts new territory in kidney transplants

A novel kidney transplant program at the Defense Department’s flagship hospital potentially could increase the number of organs available to military patients as well as civilians.

At an “organ summit” held June 13 at the White House, surgeons from Walter Reed National Military Medical Center in Bethesda, Maryland, announced a first-of-its-kind program that will transfer a kidney from a deceased donor into an ill patient who has a designated living donor, but who can’t receive his or her kidney because it is not an exact match.

The designated donor's kidney would then go to someone on the transplant list who is a match.

The system lets two people benefit from one family’s gift, explained Army Maj. Jason Hawksworth, transplant chief at the hospital. And it could serve as a model for similar donation chains nationwide.

“What we are talking at Walter Reed is doing a small, three-way chain … if it can be broadly applied as part of organ allocation nationally, theoretically, though, every cadaver donation could be used to transplant more than one person,” Hawksworth said.

He added that the setup could add several thousand kidneys to the national pipeline each year.

Walter Reed-Bethesda is the Defense Department’s sole facility for organ transplants, providing necessary surgery to active- duty personnel, retirees, family members and veterans, through partnerships with Washington, D.C.-area Veterans Affairs medical centers.

The hospital has a wait list of roughly 200 patients from across the military health system.

The military transplant program relies on an informal donation system, called “military share,” that allows families of active-duty troops to stipulate that their loved ones' organs go to another military patient or family.

The new program, organizers say, will help patients who are especially hard to match and also will help civilians, since a designated donor’s kidney would go to a match within the national organ procurement and transplantation network.
Walter Reed surgeons perform about 30 kidney transplants a year, and last year participated in the largest kidney donation exchange in the country, with 34 patients — a complex logistics operation that starts with someone who wants to give a kidney and agrees to give it to a stranger to ensure that another patient receives one.

Nationwide organ chains require intricate planning and execution, from the shipping of organs and travel logistics of patients to matching donors compatible and coordinating patient, surgeon and organ viability time schedules.

“We in military medicine excel at such challenges," said Navy Capt. Eric Elster, professor and chairman of surgery at the Uniformed Services University of the Health Sciences, following the White House summit.

"Our hope is we will know this can be done logistically. The United Network for Organ Sharing would implement this nationally. There are a lot of logistical barriers potentially to taking this national but I think eventually it will be a reality,” Hawksworth said.

Walter Reed-Bethesda officials said the first transplant under this new program could occur within six months.