Miami Transplant Institute Performs Florida’s First Three-Way Kidney Exchange

At a dramatic news conference on July 17, the Miami Transplant Institute at the University of Miami/Jackson Memorial Medical Center announced the first successful three-way paired kidney exchange in the state of Florida. In the exchange, three families with a member needing a kidney transplant each found a match in one of the other families.

The result was six surgical procedures, involving more than 30 medical personnel, which had been performed simultaneously in six operating rooms at Jackson just eight days before. The emotional high point of the news conference came when the donors and recipients, all of whom are recovering well, met for the first time.

“This is a great celebration of hope,” said Michael Goldstein, M.D., associate professor of surgery and Director of Kidney Transplantation at the Miami Transplant Institute. “The big picture for transplantation is that the waiting list is so long, many people don’t have access to transplants, and many of them die.

“Paired kidney exchange allows you to have the opportunity for a very successful kidney transplant without waiting for a long period of time. Our vision at MTI is to create new, innovative opportunities like this to improve the lives of our patients.”

Since birth, 46-year-old Mary Rivero Morales suffered from chronic glomerulonephritis — a condition that affects the part of the kidney that filters blood and also causes blood in the urine. In addition, she suffered from chronic high blood pressure. In 2012, Rivero Morales’ condition worsened, causing her to suffer kidney failure. She immediately started receiving dialysis treatments three times a week, and was informed that she would need a kidney transplant. Her husband and brother immediately got tested to see if they were a match.

“I was very worried and felt so much fear,” said Rivero Morales. “I didn’t want my husband or brother to get sick like I had been. I tried to convince them not to become donors.”

Unfortunately, neither one turned out to be the ideal match for Rivero Morales. She was then placed on the waiting list. That’s when they learned about the paired exchange kidney program at the Miami Transplant Institute. “I immediately knew I had to be part of this program,” said Omar Figueroa, 47, Rivero Morales’ husband. “I wanted to save her life, and I knew in my heart this was the best option for us to achieve that.”

Alana Gonzales, 36, was dealing with a similar fate as Rivero Morales. At age 20, she was diagnosed with lupus, a chronic inflammatory disease that occurs when the body’s immune system attacks its own tissues and organs. She suffered health setbacks when she became pregnant in 2009, which included two flare-ups, high protein levels and kidney issues. Gonzales spent two months at Jackson before she delivered her baby boy at 29 weeks, weighing only 2 pounds, via C-section. In August 2012, Gonzales began feeling tired and her blood pressure dropped. Doctors diagnosed her with chronic kidney failure stage 5, or end-stage renal disease, and told her she would need a kidney transplant. Her husband, Gabriel Garcia, 33, was immediately tested, but was not a match.

However, when Gonzales and Garcia learned about the paired exchange program, they also made the life-changing decision to participate. “I couldn’t believe I would finally find a match,” Gonzales said. “It was so incredible.”

Dale Jasko, 64, suffered from hypertension and diabetes, which led to kidney failure. He spent a year on dialysis, while waiting for a kidney transplant. His son, 22-year-old Jonathan, wanted to donate a kidney to his father, but he learned he was not 100 percent compatible.

The best option for Jasko was the paired exchange program — not only would he get a lifesaving kidney transplant, but his son would still be able to save someone else’s life. “I’m very proud of him,” Dale Jasko said. “It’s been a very emotional process.”

A paired kidney exchange, or “kidney swap,” occurs when a living kidney donor is incompatible with a recipient, and agrees to exchange their kidney with another donor/recipient. The paired kidney exchange program, which was recently launched at the Miami Transplant Institute, allows recipients to receive a better-matched kidney, and helps speed up the process for other individuals who would otherwise continue to wait for a matched donor.

In the historic three-way kidney exchange, Jonathan Jasko donated a kidney to Alana Gonzales, Omar Figueroa donated a kidney to Dale Jasko, and Gabriel Garcia donated a kidney to Mary Rivero Morales.

The donors and recipients alike expressed their gratitude for being able to participate in the swap program in a way that helped a stranger as well as themselves or a family member.

“I’m very grateful to get a second chance at life,” said Dale Jasko. “I can look forward to seeing my son graduate from college and eventually to having grandchildren.”
“There are no words to describe my feelings,” said Alana Gonzales. “I wasn’t giving my 4-year-old son the quality of life he deserves, and I wasn’t giving 100 percent at work. Now I can feel my energy returning. I thank God, and I thank the wonderful staff at Jackson.”

Goldstein was joined at the news conference by nine other members of the transplant team: Rodrigo Vianna, M.D., professor of surgery and Director of Transplant Services and Chief of Liver and Gastrointestinal Transplant at the Institute; Jose M. Martinez, M.D., associate professor of surgery and Section Chief of Surgical Endoscopy; Gaetano Ciancio, M.D., professor of surgery and urology, and Chief Medical Officer of the Miami Transplant Institute; Giselle Guerra, M.D., associate professor of clinical medicine and Medical Director of the Living Kidney Donor Program at the Miami Transplant Institute; Michelle Gascon, Transplant Nurse Manager, Kidney and Pancreas; Ester Montenora-Velarde, B.S.N., RN, Clinical Transplant Coordinator; Tamika Hill-Matthie, RN, Clinical Transplant Coordinator; Shirlene L. Hazel, RN, Clinical Transplant Coordinator; and Alejandro Lugo, M.D., resident.

Guerra discussed the care with which the matches had to be made, as well as the plans for growth for the paired exchange kidney program.

“It took a long time to make this happen,” she said, “because we wanted to find the best match for each of them. The recipients here received organs from individuals that we felt were the best match for them — not only based on their age, but also genetically — and that gave them the best opportunity for a long, healthy life. We’re also expanding the program within our center and within the southeast region. We expect that Orlando and Tampa will join us, as well, and we will be able to increase the chances of finding the best kidneys for all potential recipients.”

“This is just the beginning,” said Goldstein. “There are opportunities to create a kidney chain, whereby a single donor begins a chain reaction of transplantation that extends across the entire country. We’re going to start small, and escalate and help as many people as we can. We want to make UM/Jackson the destination transplant hospital in the Americas.”

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