Cross-over donation: blind date for two kidneys
Christiane Fux studied journalism and psychology in Hamburg. The experienced medical editor has been writing magazine articles, news and factual texts on all conceivable health topics since 2001. In addition to her work for, Christiane Fux is also active in prose. Her first crime novel was published in 2012, and she also writes, designs and publishes her own crime plays.
More posts by Christiane Fux All content is checked by medical journalists.Humans can live well with only one kidney. It is therefore possible to donate one of the organs alive. In Germany, only close family members and confidants are allowed to do so. But what if the donor and recipient do not match? That was exactly the case with Monika and Günther Breuer *. Here we tell how Monika got a new kidney.
"Living donation of a kidney or part of the liver is now possible for over 90 percent of couples," says Prof. Christine Kurschat, senior physician at the Cologne University Hospital in a NetDoctor conversation. “With the remaining couples, the problem is usually that the recipient has developed antibodies against the donor's tissue. Then when you do a transplant, the immune system really goes up and rejects the transplant. "
Kidneys full of cysts
That was exactly an obstacle for Monika and Günther Breuer * too. "When Prof. Kurschat told me that she was terribly sorry, but that my husband was out of the question as a donor for me - that was quite a shock," she reports in an interview with Monika suffers from a familial cyst kidney. In the course of life, more and larger cysts form in the kidneys - which is why the organs work less and less.
Her husband says: “Monika was about to start dialysis and was increasingly exhausted. We looked at such an ambulance and knew what was in store for my wife. For hours of blood washing every three days - that would have been a great burden for my wife and therefore also for me. ”Work, family, honorary positions, hobbies - all of this would only have been possible to a limited extent.
Cross donations
But her doctor doesn't give up that easily. She has built up a pool of around 40 donor-recipient pairs who also do not match. She hopes to be able to help the couple from the Eifel with a so-called cross-over donation.
The idea behind the procedure is as simple as it is ingenious: if two patients have a relative willing to donate, but who does not “match”, another couple is sought in the same situation, in which the biological prerequisites for mutual donation are given. And the kidney specialist actually struck gold: Volker and Susanne Petersen *.
Couple swap for transplant
The living donation problem is somewhat different for the couple from Bremen. Volker would also need a new kidney, but his blood group and that of his wife are not compatible. "In most cases that can be solved today," explains Kurschat. Because now you can wash out blood group-related antibodies from the recipient's blood before donating. The procedure is called "AB0-incompatible living donation". However, this does not work for one in seven couples. But Susanne is an option as a donor for Monika, and Günther suits Volker.
Chains of 30 living donations
In countries such as the Netherlands, Austria, Spain and the USA, a cross-over living donation could now be initiated without any problems. Entire exchange chains with up to 30 donor-recipient pairs are possible there. When the doctor reports this, she sounds a little wistful.
Because the German transplant law puts a stop to this in this country: For living donations, it stipulates that there must be a deep personal bond between donor and recipient. Close relatives and friends are almost exclusively eligible. This is to prevent organs from being secretly sold instead of donated.
The prerequisite is a close bond
How exactly the law is interpreted, however, is a matter of the state. In North Rhine-Westphalia, where Kurschat looks after their patients, it is enough if the couples meet a few times before the procedure - and can make it credible that a trusting bond has been created.
And so Monika and Günther got into the car to meet Susanne and Volker near Lübeck. “We were pretty excited,” reports Monika. “It was like a blind date!” Günther reports that he was happy to have a look at the recipient of his kidney in advance. “I didn't want it to go to someone who didn't treat it responsibly,” he says.
"Love at first sight"
But when they finally meet in the hotel restaurant, all doubts are instantly gone. “That was love at first sight!” Says Monika. It doesn't stop at one meeting: “In order to convince the ethics committee in the hospital, we had to meet more often. After all, we had to show that there was a relationship of trust. "
Even after the donation, the two couples keep in touch, they talk on the phone regularly and send each other photos, and go hiking together.On the anniversary of the transplant, they meet again regularly in November - except this year because of the coronavirus pandemic. “It was always a pleasure. We shared the same fate. So we were able to exchange ideas, ”says Monika.
A database for the "partner swap"
Nephrologist Kurschat would like to set up a nationwide donation register in order to give more victims the same chance as Monika and Volker. “Patients who develop tissue antibodies usually have many of them in their blood. Finding someone who still fits is not that easy, ”she says. The larger the pool, the greater the likelihood of finding a donor.
However, collecting and comparing the required data means a high logistical effort. “You have to match the surface features, and it's not that easy to do by hand. In order to pick out the most suitable pairs, you need an appropriate computer program, ”says the kidney specialist.
It would also be advantageous if cross-over donations were also possible in all other federal states. But most interpret the conditions for living donation more strictly. A mixed double like Günter and Monika and Susanne and Volker would not be possible there. “If four adult people agree and want that, then I cannot understand why they are denied such an operation,” says Monika.
She herself only came to the cross-over donation by chance: Her sister gave her the tip to attend an information event on living donation in the Cologne University Clinic. There she met Prof. Kurschat. “Otherwise I would have to rely on dialysis today. A stroke of luck. "
Living donations are often more successful
Because of the residual risk of transplantation for healthy donors, organs of deceased people are still preferred to be transplanted in Germany - although living donation is more often successful. Because the donors must be largely healthy and the organ can be used immediately after removal. "We have already had the case that we had prepared someone for living donation, but then received a suitable organ from a deceased person from Eurotransplant," reports Kurschat.
However, this means that the German legal situation automatically means that the organ is no longer available for another kidney patient who does not have a living donor by his side. In 2019, there were around 10,000 people on the waiting list, compared to only 932 organ donors. "Most people with severe kidney disease wait around eight years for an organ," says Kurschat. In the end, many are so sick that they are no longer an option as recipient.
A nice kidney for Monika
For Günther it was a matter of course to give a kidney for his wife - even if it ended up in Volker's body. “That's why I now have Susanne's,” says Monika. “The doctors always tell me that this is a particularly beautiful specimen. But Susanne is also a particularly beautiful woman, ”she says and laughs.
The Breuers are promoting cross-over donations so that more people can benefit from living donations in the future. “That is really extremely important to us!” Says Monika. “Something has to be done!” She and her husband are incredibly grateful that committed people like Prof. Kurschat made the cross-over donation possible. "But there are still so many who are dependent on dialysis and who may wait in vain."
* These names were changed at the request of the interlocutor
