Walter Reed Joins National Kidney Exchange Pool

By Terri Moon Cronk
American Forces Press Service

BETHESDA, Md., Oct. 3, 2012 – Walter Reed National Military Medical Center is the first military hospital to join and participate in a national network of civilian centers for a kidney transplant exchange, the chief of the center’s Army-Navy Transplant Program said.

Army Col. (Dr.) Edward Falta explained that the exchange -- the National Kidney Registry, or NKR -- allows voluntary donor-and-recipient pairs who aren’t compatible based on immunological differences to donate and receive live donor kidneys from others in similar situations from the network. Barriers can be blood-type incompatibility and antibodies that developed over a lifetime, he said.

Overall health and age also factor into transplantation equation, he added. “Everyone works to find combinations that will benefit everyone,” he said. “The more people who enroll, the more possibilities there are.”

The NKR received the go-ahead from the Defense Department in June. Walter Reed’s first kidney exchange using the national registry involved a military couple and took place Aug. 21. Seven donor-and-recipient pairs now await transplantation at Walter Reed through the registry.

A typical military transplant candidate is 20 to 30 years old, and often has developed undetected kidney disease from birth or at a young age, Falta said. Most civilian patients are age 50 and older, he said, and need transplants primarily because of hypertension, followed by diabetes.

“The national cadaver pool of donors serves the average person waiting in the civilian community,” Falta said. “For us, we’re weighted more towards the younger patient, so we have to look for ways to provide age-matched kidneys for our patients so as to only have one transplant last the rest of their lives.”

This, he said, provides an advantage for live donor kidney availability in the exchange program. “It helps us compensate for the population age we provide medical care for,” Falta said.

Walter Reed is not unfamiliar with performing kidney transplants -- the facility averages 30 to 40 such operations a year, staff officials said. For many years, the former Walter Reed Army Medical Center and now the new consolidated facility here have taken part in a local kidney exchange program with hospitals in the area.

Falta said he views the national registry as a component of Walter Reed’s existing transplant program that broadens the opportunities for patients who need kidneys. The live-donor exchange, he said, greatly shortens the waiting time for an organ.

“What is unique about this [national] program is that it’s not a technological or medical breakthrough. It involves logistics, mathematics and trust between the different medical centers and families that participate,” he added.

In certain situations, Falta said, a service member kidney recipient might return to duty.

“We have some transplant recipients who are still on active duty, but it’s [decided] on a case-by-case basis,” Falta said, adding it’s difficult to return a service member to duty because kidney recipients have ongoing needs for medication, medical monitoring and laboratory work. Return-to-duty decisions also can be service-specific, and involve factors such as the length of a service member’s career and whether that military specialty can be performed in a garrison setting, he said.

Numerous benefits exist for the military in the kidney exchange program, Falta said, with availability of high-quality organs with less immunosuppressive medications being the primary benefit.

“Kidney transplantation is much more cost-effective than replacement therapy like dialysis,” he said. Waiting for a kidney while being maintained on dialysis is very expensive for patients, their families and the health care system, so a live kidney donation reduces the waiting time, Falta said.
“Receiving kidney transplants earlier rather than later is cost-effective with fewer medical complications,” he added.

Walter Reed is one of the lower-volume centers in the country, but boasts one of the highest success rates. “We’re very proud of our results,” Falta said. “Part of our success is because of the military community we serve, the network of military medical care across the country, and the ability for the military services to coordinate on the health care front to take care of these patients.”

Walter Reed participates in the kidney exchange with Sharp Chula Vista Medical Center in San Diego, Rush University Medical Center in Chicago, New York-Presbyterian/Weill Cornell Medical Center in New York, Methodist Specialty and Transplant Hospital in San Antonio, Ronald Reagan UCLA Medical Center in Los Angeles, the University of Pittsburgh Medical Center in Pittsburgh and the Hospital of the University of Pennsylvania in Philadelphia.