Wilhemenia Freeman was driving to work six years ago when, she said, God spoke to her.
"He said, `It's going to be your kidney,'" said Freeman, 49, who lives in Ellicott City, and she believed.
She believed even after doctors told her she couldn't donate a kidney to her husband, Bill Freeman, whose kidneys had failed a year earlier, because her blood type wasn't compatible. And she kept on believing while her husband languished on dialysis for two more years with little hope of getting an organ from an outside donor.
Then Lloyd Ratner, a doctor at Johns Hopkins Hospital, appeared with a plan. He called the Freemans in December 1998 and offered to do what they had been told was impossible - give Bill Freeman, 52, one of his wife's incompatible kidneys.
"The first thing you learn when you start learning about transplants is you don't cross the blood type barrier; it's contrary to every rule," Ratner said. "But we were pretty sure we could do it successfully ... and Mrs. Freeman was totally committed to [donating], no matter what it took."
So, on Oct. 1, 1999 - three days before their 19th wedding anniversary - after months of tests and preparation, Bill Freeman became the first person to receive a blood-type incompatible transplant at Johns Hopkins. And, nearly three years later, he's going strong. (Another Ellicott City resident, Mary Halpin, was the second recipient).
Now, the Hopkins Incompatible Kidney Transplant Programs team has released data claiming the highest success rate for this type of transfer: a 93 percent kidney survival rate, compared with 81 percent worldwide.
The Hopkins numbers, though based on a relative handful of patients, are drawing attention because they suggest that this combination of treatments might be one others could adopt with equal results, potentially increasing kidney transplants by one-third or more.
Doctors say components of the procedure may have potential for use in other types of transplants, including liver and heart, though no research has been announced.
According to the National Kidney Foundation, about 300,000 Americans have chronic kidney failure, which means their kidneys can no longer filter wastes from their bodies. They need dialysis, which simulates kidney function, or a transplant to stay alive.
But transplants are hard to come by. There are nearly 50,000 people on the national waiting list for cadaver kidneys, according to the Scientific Registry of Transplant Recipients. Kidneys aren't widely available, though; 16 percent of those on the list (8,069 people) received organs last year. Six percent of them, 2,837 people, died while they were waiting.
Live donor organ transplants are preferred over cadaveric transplants because they're more likely to succeed. But finding people willing to give up one of their kidneys is not easy. Even those who have a willing donor run into problems, largely because of blood type incompatibility, which doctors call ABO incompatibility. Some sensitized recipients have developed antibodies that make transplantation difficult regardless of blood type.
"This procedure has eliminated the barrier that has kept thousands of patients from receiving a life-saving transplant," said Hopkins surgeon Robert Montgomery, who removed Wilhemenia Freeman's kidney for the transplant and presented the study data at the American Transplant Congress. "It's given a lot of hope."
While the procedure has only been performed on a small group, word is starting to spread. Hopkins doctors are being invited to speak about it at other hospitals, and potential recipients are contacting them.
"We've been getting calls from all over the country and Canada, Singapore, Italy," said Janet Hiller, the Hopkins nurse in charge of coordinating transfers and educating people about the procedure. "That's exciting. You realize you're offering people something that before now they haven't been able to receive."
The Hopkins procedure calls for stripping the recipient's blood of rejection-inducing antibodies through several rounds of a dialysis-like process called plasmapheresis before transplantation. Doctors then give the patient medication that suppresses the antibodies' return, along with standard immunosuppression drugs after the surgery. The patients' spleens, which produce antibodies, are removed.
The process won't work with a cadaveric organ because there's no time for preparatory plasmapheresis. Kidneys must come from live donors.
Risks identified include a higher chance of rejection (compared to a fully compatible transplant) during the first three years after the surgery, as well as the danger of infection because of the removal of the bacteria-fighting spleen.