Kidney donated two weeks after transplant

Transplant recipient donates kidney after disease threatens the organ; re-implantation reverses damage and allows another patient to thrive

For the first time, a kidney that had been donated to a patient in need was removed and implanted into a new patient, the third individual to have the organ, after it failed in the first transplant recipient. Ray Fearing, a 27-year-old Arlington Heights resident received the organ from his sister, Cera, after a long battle with focal segmental glomerulosclerosis (FSGS), a disease in which scar tissue develops on the part of the kidney that filters waste out of the blood, ultimately causing kidney failure. When signs of his illness reoccurred just days after he received the organ and posed life-threatening symptoms, doctors informed Fearing that they would have no choice but to remove the failing kidney. They also informed Fearing that he could potentially save someone else's life by donating the organ and allowing doctors to re-implant it into another patient in need of transplant, something that had never successfully been done before with a kidney.

"In over 50 percent of cases, transplant does not stop the process of FSGS. When post surgery tests indicated that Ray was at risk of developing life-threatening conditions due to the reoccurrence of the disease, we had to remove the kidney before he deteriorated. The kidney however was still a relatively healthy, viable organ that could be transplanted into someone else without FSGS," explained Lorenzo Gallon, MD, transplant nephrologist and medical director of the kidney transplant program Northwestern Memorial Hospital and associate professor of medicine and surgery at Northwestern University Feinberg School of Medicine.

Northwestern Medicine- experts and members of the medical ethics committee reviewed the proposed procedure and evaluated the decision prior to re-implanting the organ. The group discussed potential risks, which included the possibility that the kidney would fail to recover from its current level of minor damage due to its short exposure to FSGS while implanted in Fearing, thus failing to function properly in a new patient.

"After numerous discussions to carefully consider this first-ever procedure, we presented Ray with the option to donate his kidney to someone on the national kidney waiting list rather than discarding it," said Gallon.

Fearing did not hesitate when he found out he could help someone in need like himself. Two weeks after receiving his kidney transplant, he donated his kidney to 67-year-old surgeon and father of five, Erwin Gomez.

The organ regained function almost immediately after re-transplantation and just eight days after transplantation, tests showed a reversal of the damage caused by the FSGS in Fearing's body.

"This is a ground-breaking medical moment because it suggests that it is possible to reverse the damage done to a kidney as a result of FSGS after it is re-transplanted into a body with a healthy circulatory system," said Joseph Leventhal, MD, PhD, transplant surgeon at Northwestern Memorial Hospital and associate professor of surgery and director of kidney and pancreas transplantation at Northwestern University Feinberg School of Medicine. "Not only did we save a viable organ from being discarded, we also made significant strides in better understanding the cause of FSGS, which has been relatively unknown, so we can better treat the disease in the future. This proves that when an organ fails in one body, it may thrive in another."

This innovative idea and resulting discovery is featured in the April 26 issue of the New England Journal of Medicine.

Fearing is back on dialysis to control his FSGS and is hopeful he will receive another kidney transplant in the future.

"It may not have been my time, but I am grateful that I was able to help another patient," said Fearing. "My day will come."