When her sister's kidney transplant failed after six years, Mary Keehan began thinking about whether she could donate one of her own kidneys for a second operation. Then she heard about a new surgical procedure that made the decision to be a living donor easy.
Mrs. Keehan, 46, gave her sister, Verna Barranco, one of her kidneys last July in an unusual operation designed by doctors at Johns Hopkins Bayview Medical Center to expand the donor supply. Her kidney was removed by laser surgery, speeding her recovery to weeks instead of months, eliminating the long, ugly scars and significantly reducing the pain, too. She went home in six days.
Amid a perilous shortage of kidneys to extend the lives of people like Mrs. Barranco, a 37-year-old Harford County nurse, doctors are exploring new surgery techniques to make it easier to give.
"A lot of people would love to donate but they can't because they would have to take off from work," said Lloyd E. Ratner, chief of kidneys at Bayview who performed the transplant with Louis R. Kavoussi, a urologist and expert on laproscopic surgery.
"The idea came to us because when we'd ask potential living donors, they would ask us, 'How long will I be out of work?' For plumbers, people who load trucks, people who are self-employed with three kids, the question is always, 'Who is going to pay the bills?'"
Living donors -- often sisters, brothers, sons, daughters or spouses -- have long been a way to increase the organ supply. In states like Maryland where the wait is among the longest in the country, they represent 35 percent of all kidney transplants.
For the recipient, a kidney from a living donor is always better. Transplants from donors who have died have a success rate of 85 percent after one year compared to 95 percent for transplants from living donors.
Mrs. Barranco, who has a daughter, Ashley, 11, is back at work with few of the negative symptoms that accompanied her first transplant. Her new kidney could last 30 years.
The experiment by Drs. Ratner and Kavoussi is being eagerly followed by doctors nationwide. So far, seven people have given their kidneys to relatives in the surgery being pioneered at Bayview. All but one have been successful. Dr. Ratner isn't ready to publish the findings, but already the work is creating a stir. John Fung, chief of transplant surgery at the world-renowned University of Pittsburgh, calls it a potentially amazing development. "If it works, that's great," he says. "I have to admire their innovation."
In the laproscopic procedure, doctors make four one-inch incisions and insert the instruments they use to free the kidney. Then they extend the incision under the belly button three inches, reach in, and pull out the kidney. The traditional method is to make an incision half way around the body.
Because of the time it takes for muscle to heal, donors whose jobs involve heavy lifting or other physical labor can be side-lined for as long as two months.
Dr. Kavoussi and Dr. Ratner spent two years in the lab perfecting the operation before trying the first one on a patient in February 1995. Mrs. Keehan came away believing in them.
"All I needed to know is, 'if everything worked out as planned, would it make a big difference to my sister and would it be harmful to me?' " she says. "Yes, it would make that much difference and yes, a person can live with one kidney as well as with two."
Pub Date: 3/27/96