Ribs and Asparagus

There is an enormous (and growing) discrepancy between the number of people who WANT kidney transplants and the number of people who are able to get them. The waiting time varies by region, but in Massachusetts the wait time is between 3-5 years on average (a sobering statistic especially considering the crappy mortality rates on dialysis I quoted in my last post). Another interesting strategy for increasing the pool of kidneys available are "kidney exchange programs."

Here's how it works: say that Mr. Ribs has end-stage kidney disease and his wife, Mrs. Ribs, is willing to donate. The first thing to do in this instance is see if Mrs. Ribs is a "match" for her husband. This takes into account several factors, the most important being the blood type (A, B, or O) and the identity of MHC genes (which are involved in your immune system). If the kidney is a good "match" Mrs. Ribs could then likely proceed with the kidney donation. However, if there's NOT a match--for instance, if Mrs. Ribs had blood group A and Mr. Ribs blood group B--you would likely see an immune attack of the donor organ within minutes of transplant (in cases where this has happened in the past, the surgeons can actually see the transplanted kidney swelling up and turning black before their eyes)--obviously Mrs. Ribs couldn't donate her kidney to her husband.

But she could donate her kidney to a stranger who has type A blood. Say that there's a second couple, Mr. Asparagus (blood type A) who needs a kidney and his wife Mrs. Asparagus (blood type B), who wants to donate to her husband but can't for the same reasons. What kidney exchange programs (like NEPKE, the New England Program for Kidney Exchange) seek to do is match up different incompatible pairs so that Mrs. Asparagus would donate her kidney to Mr. Ribs and Mrs. Ribs would donate her kidney to Mr. Asparagus. The transplants are typically carried out on the same day (likely in part to make sure that both sides follow through with the deal). Mmmm, ribs and asparagus. It's a win-win situation.

In other news, I saw a very interesting case of Sjogren's Syndrome-associated cryoglobulinemic membranoproliferative glomerulonephritis the other day.