For Gail McCauley, replacing her damaged kidneys might have been fairly straightforward. Her son wanted to give her one of his kidneys. They imagined checking in to the hospital together for the surgery.
But as often happens, his tissues were a poor match for her.
Yet TJ McCauley still gave up a kidney for his mother. The gift just ended up becoming a cross-country affair spanning three months, nine states, 16 donors and 16 recipients.
The elaborate swap marked the Tampa Bay area's first brush with a concept so new that many still grapple with its ethics and logistics. But kidney donor chains are rapidly expanding to meet the surging demand for transplants.
Like Gail McCauley, people with failing kidneys often have a friend or a relative willing to donate. If their blood types or antibodies are mismatched, however, the organ would be rejected, leaving the pair with little recourse.
But what if a donor could help his or her loved one procure a kidney by donating to someone who is a match?
Thirty-two people at a dozen hospitals from Florida to California recently joined the chain that gave McCauley a new kidney. It started with a "good samaritan donor" — a 35-year-old man who wanted to give a kidney to anyone who needed it — and ended in New York with a transplant for a 15-year-old boy who didn't have a living donor.
Along the way, the chain nearly fell apart nine times. But each time, organizers got it back on track.
"We've got to get the word out to people on dialysis," said Garet Hil, founder and president of the National Kidney Registry, which organized the recent chain through Tampa. "A lot of time they will have incompatible donors and they won't even think they can get transplanted."
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Kidneys are the only organ for which living donor chains are feasible. People can live with just one kidney, and the surgery is considered fairly safe for the donor. And kidneys from living donors are less likely to be rejected and tend to last longer than cadaver organs.
While living donations have become commonplace since the 1990s, nearly 88,000 Americans are awaiting a kidney.
"Obviously the huge problem is the lack of supply and the great demand," said Dr. Kenneth Andreoni, chair of the kidney transplantation committee for the United Network for Organ Sharing, which manages the nation's transplant system.
Enter the concept of paired kidney exchanges. In recent years, advances in technology and tissue typing have opened the door to identifying perfect strangers whose biochemistry would make a transplant match.
Last year, 380 kidney transplants occurred between non-related donors and recipients, according to UNOS statistics. That's three times as many as in 2007.
Experts estimate that these exchanges could lead to an additional 2,000 to 3,000 living donor kidney transplants nationally each year, Andreoni said.
Like many such chains, Tampa Bay's first one started with a good samaritan. That way, if a link in the chain breaks due to a donor backing out or a recipient suddenly getting another kidney, donor-recipient pairs down the line remain intact and can enter another exchange.
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Gail and TJ McCauley were in the third round of Chain No. 95.
The 64-year-old Davenport woman was so amazed to be part of a cross-country exchange that she couldn't worry about everything falling apart.
"It was like it wasn't real anyway," she said. "I was like, 'If it happens, it happens.' "
Her kidneys, damaged by an infection two years ago, were performing at just 15 percent of normal. McCauley had managed to avoid dialysis, though her doctors knew that couldn't last much longer.
She had been told her new kidney was coming from a donor in Seattle, and that her 43-year-old son's kidney would go to Pittsburgh.
TJ McCauley arrived from his home in the St. Paul, Minn., suburbs for the Feb. 10 surgery at Tampa General Hospital. Just like a traditional living donation, he would have his operation near his mother.
As the day approached, Tampa General's transplant administrators scrutinized the weather forecasts and fretted about flight delays.
But on Feb. 9, all went as planned:
The UCLA Medical Center sent a kidney from Los Angeles to New York-Presbyterian/Weill Cornell Medical Center in Manhattan.
Cornell donated the next kidney to San Diego.
San Diego donated to Seattle.
And at 10:45 p.m. Pacific time, the kidney promised to Gail McCauley departed Seattle in an ice-filled cooler in the passenger cabin of an Alaska Airlines red-eye flight to Orlando.
By the time it touched down at 7:05 a.m. Eastern time, Feb. 10, TJ McCauley was in surgery.
At 2:50 p.m., his kidney arrived in the operating room at the University of Pittsburgh Medical Center, activating the next link in the chain.
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UNOS's kidney transplantation chairman envisions a future where donor chains aren't such dramatic events.
"Hopefully, 10 years from now, this is just a common occurrence," said Andreoni, an associate professor of surgery at Ohio State University. As more people get involved, organizers can more easily make matches and "the fewer of the crazy-numbered long things need to be done," he said.
Critics say these chains favor patients with living donors, who usually are a ticket of sorts to the chain. But each person receiving a transplant this way frees up an organ for those on the deceased donor wait list.
Uncertainty is always a factor in organ donation.
"Whether it's a relative, a friend, a neighbor or someone across the country, it's a question mark as to whether or not everything will line up," said Angie Korsun, administrator of the transplant program at Tampa General.
"Everyone crosses their fingers and toes a lot, says a lot of prayers and lights some candles."
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As the organizers of Chain No. 95 swapped congratulatory e-mails, Gail and TJ McCauley recovered uncomfortably at Tampa General. He didn't like the hospital food. Her blood pressure was low.
But Gail McCauley giggled when a side dish of pickles arrived with her scrambled eggs one morning. For two years, she had carefully avoided salty foods so as not to overtax her kidneys.
Now her doctor wanted her to eat pickles with every meal. She needed the sodium to bring her blood pressure to normal.
TJ McCauley flew home a few days ago, after recuperating at his mom's home under the care of his father, sister and wife. He expects to be exercising again in a few weeks.
"People say that you only need one (kidney) for a reason," he said. "My mom needed one more than I needed two."
And doctors say Gail McCauley and her new kidney are off to a great start.
"I just want to shout out to the world about this," she said of the donor chain. "How many lives it might change if people knew about them?"
Letitia Stein can be reached at firstname.lastname@example.org or (813) 226-3322.