Largest internal living-donor chain at MUSC gives new life to four patients

Thanks to the generosity of four people, four more received new kidneys and with that, new lives. The donation of a “Good Samaritan,” or someone with no connection to the donor, lit the spark for an eight-person exchange that helped four people suffering from kidney failure.

The story behind the chain

After three long, consecutive days of surgeries – four to remove kidneys, four to implant them – eight people made their way into a small room in MUSC’s main hospital. Some wore hospital gowns, others, street clothes. Most of these people were complete strangers to one another, but today was the day they would each come face to face with someone who they shared not only a special bond with but who they’d forever share a part of. 

Two years ago, Cassandra Bilyeu was browsing Facebook when she saw a post from a friend of a friend. This person needed a kidney transplant, and therefore a donor. “So I signed up and registered to be a kidney donor. Why not?” she asked. Thankfully, the person she signed up to donate to had already found a donor, but Bilyeu decided to follow through with a donation anyway, even if it were to go to a stranger.

Cristi Maw was also moved to donate a kidney from a Facebook post. After she supported a coworker through the donation process, she felt called to do the same. When she saw Maggie Dean’s post about needing a kidney. “I just thought, ‘I want to help her,’” she said. Even though Maw wasn’t a match for Dean, the possibility of a chain gave them both hope.

 

The Rev. John Kronz is a 32-year-old minister in the small town of Norway, South Carolina. Two years after watching his grandmother die of kidney failure, he felt compelled to help when one of his parishioners, Bonnie Fanning, mentioned that she needed a transplant. “He hadn’t been in the church very long,” she said. “He said, ‘I’d like to donate you a kidney’ and I was like, ‘Yes! That would be wonderful.’” But the pair would also need a chain for a successful transplant, since they also were not a match.

Cameron Coleman was 15 weeks pregnant when she received the diagnosis that her kidneys were failing. She went on dialysis six days a week while she was pregnant, and after delivery, she went every day. Her father, Mike Riley, signed up to donate his kidney to help her, but, as fate would have it, they also weren’t a match.

But there was good news. As it turned out, the stranger that Cassandra Bilyeu would donate a kidney to was Maggie Dean. And though Cristi Maw wasn’t a match for Maggie Dean, she was indeed a match for new mom Cameron Coleman, who after four months of waiting, got her new kidney. And, as remarkable, her father was able to donate his kidney to Bonnie Fanning.

That left Carlos Zavala-Tellez, a man who didn’t have a previous connection to anyone in the room. A few weeks prior, he was on a waiting list for a new kidney. Thanks to the generosity of four altruistic donors who stepped forward – especially John Kronz – he got one. “I have a son and a daughter, so I’ve got a lot of reasons to keep living. I want to live for a long time and take care of them as much as I can,” he said. “Thanks to generous people who help people that they don’t even know.”

The robotic donation process

Teresa “Tracy” Rice, M.D., piloted a program to bring robotics into kidney transplantation. MUSC performed its first robotic kidney transplant surgery in 2021, and by the end of this chain, Rice had completed the 60^th. This program has not only helped doctors to be quicker and less invasive in their surgeries, it’s also improved recovery time for donors.

“We’ve grown our program pretty rapidly in terms of robotics,” Rice said. “I’m doing them all robotically now and making that our standard of care. It has a lot of benefits to our living donors. They have a reduced hospital stay; over 90% of our patients are now going home the day after surgery. More importantly, it’s a safer operation for our living donors. The combination of robotic surgery and our enhanced recovery pathways allows for a quicker and safer recovery. Donor safety and comfort is always my number one priority.”

 

In a traditional surgery, the surgeon stands over the patient to operate. But in a robotic surgery, the surgeon sits at a console and uses joysticks to control four robotic arms that contain a camera that gives a 3D view and tools to perform the surgery. Heather Achinson, R.N., a former nurse who now works for Intuitive Surgical helping clients like Rice make the best use of this robotic surgery technology, explained that the term “robotic surgery” gives some people the idea that doctors aren’t doing the surgeries themselves.

“When we speak about robotics, particularly for people who aren't familiar, they do kind of operate under the assumption that the robot is doing the surgery,” Achinson said “What the robot really allows is for the surgeon to utilize the full scope of their knowledge and open techniques but in a minimally invasive fashion. Robotics allows for a three-dimensional view, 10-times magnification, improved visibility and full-wristed articulation. Ultimately, what that means is that it is a safer surgery, and a lot of times, and what Dr. Rice’s data is showing, is that that leads to less pain and less post-op complications.”

Rice also said that living donors provide better kidneys. “The gold standard is a living donor,” she said. “We can reduce dialysis, which improves their survival, and the kidneys last longer from a living donor. It eliminates that wait time and ultimately saves more lives.”

Instant bonds

The decision to give a kidney, even to someone he just met, was an easy one for John Kronz. “I think it’s something that should be more normalized,” he said. “It’s pretty normal to give blood nowadays; I’d like people to know that this is something that’s not a dangerous thing to do.”

 

Rice said that if you’re looking to step out and help someone, don’t assume you can’t help just because you aren’t a match. Exchanges like this one can be the answer for both the person you know and another person.

“A lot of people will be in a clinic with their spouse, and their spouse is eager to donate. But they say, ‘I can't donate because I'm a different blood type,’” Rice explained. “But these exchanges allow us to overcome some of these barriers, increase the number of transplants that we can do and ultimately save more people’s lives. Organ donation is a wonderful gift, and it is an honor to be able to care for these donors who are true heroes.”

As Rice walked in that hospital room, she looked around. And along with hugs and tears, she saw the perfect example of overcoming barriers: four donors who had come forward to help someone who in some way mattered to them – only to be told that it wasn’t possible. Yet help they did. Not a one deterred. And with that combination of courage and kindness, the lives of four people – strangers they had never laid eyes on – were saved. For transplant surgeons like Rice, these are the happy endings that make it all worthwhile. 

Those interested in joining MUSC’s living donor program can visit the program’s page to learn more and sign up.