It sounds like one of those logical brainteasers that almost no one can solve: You have three pairs whose partners don't match each other but might match members of other pairs. By shuffling, can you come up with three perfect matches?
The answer was a happy "yes" at Johns Hopkins Hospital, where 15 doctors operated on six patients over 11 hours Monday to transplant three healthy kidneys into three desperate recipients.
The "triple switch" was almost certainly the first such maneuver in history, Johns Hopkins officials said. As of yesterday afternoon, all six participants were safe and comfortable.
"Logistically, this was monumental," said surgeon Robert A. Montgomery, who led the transplant team and operated on two of the six. "We were all truly amazed that it worked out."
The complex transaction boiled down to a barter among three pairs of people. Each twosome consisted of someone who needed a kidney and someone willing to give up a kidney. Each pair already knew each other, or were related, and were willing to be transplant partners. But because their blood and tissues didn't match, transplants between them wouldn't work.
So they turned to Hopkins' Incompatible Kidney Transplant Program, which cross-matches such donor-recipient pairs. Since 2001, Hopkins has performed four double transplants this way, but this was the first time it took three pairs to get everyone matched perfectly.
How did the exchange work?
Let's start with Tracy Stahl, an Appleby's waitress with two kids from Johnstown, Pa., who got her new kidney from Julia Tower, an educational consultant from Hyattsville.
Tower's partner and family friend, 13-year-old Jeremy Weiser-Warschoff of Silver Spring, in turn got a kidney from Paul Boissiere, a 30-year-old electrical engineer from Trinidad who lives in Coral Gables, Fla.
Meanwhile, Boissiere's fiancee, accountant Germaine Allum, 30, in turn got a kidney from Connie Dick, 41, a contractor from Latrobe, Pa., who happens to be Tracy Stahl's sister.
Did you follow that?
Speaking publicly for the first time at a news conference yesterday at the hospital, five of the patients laughed, cried and thanked their doctors - and each other. The only one missing, seventh-grader Jeremy, stayed in his hospital room to save energy for playing pool later in the day.
"She gave me my life back," said Tracy Stahl, 39, looking at Julia Tower, 57, who lay in a gurney a few feet away.
Tower said that when she met her kidney's new owner, she felt an immediate connection. "I looked into Tracy's eyes and felt a bond, " she declared. The two met for the first time yesterday, an hour before the news conference.
The hospital had kept donors' identities secret from recipients - and vice versa. Yesterday, with everyone seemingly on the road to recovery, all six agreed to waive their anonymity.
Stahl said she wanted to stay in touch with all the participants and their families, a sentiment echoed many times.
`Helping a kid'
Paul Boissiere held up a small picture of his recipient, Jeremy. "It's a different feeling when you're helping a kid," the engineer said.
Together, the six operations cost about $300,000, Hopkins officials said - about average for three kidney transplants. Recipients' insurance companies are expected to cover most of that.
Officials said the matched-pair approach offers two advantages over normal transplants. If they can find a matching pair, recipients can avoid transplant waiting lists, which can take years. As of July 25, there were 55,249 people in the United States waiting for kidneys, according to the United Network for Organ Sharing. Last year, only 14,770 people received transplants.
A matched pair also guarantees a kidney from a living donor. While organs from cadavers are regularly transplanted, they tend to fail more quickly than those from the living.
The beauty of the matched pair transaction is its symmetry, said nurse Janet Hiller, transplant coordinator for the Incompatible Kidney Transplant Program. Each pair gets a kidney and also gives one up.
"The most amazing thing about this is the donors, who are willing to give up a kidney to a stranger so that their loved one can get one," said Hiller, who worked on the intricate swap for two months.
Montgomery, the lead surgeon, called Hiller the "kidney matchmaker."
"She's the one who quarterbacked the whole thing," added surgeon Alan Hawxby, a transplant fellow who helped operate on Allum.
Hiller and her co-coordinator, Jennie Rickard, each carried a kidney from one operating room to the other. Because the ORs were in different buildings, they had to walk a block to make the handoff. The kidneys made the trip in regular coolers (Hiller bought them at Wal-Mart), triple-bagged and packed in sterile ice.
"You're nervous because you don't want to drop the cooler," said Rickard.
Both saw the short walk as a great honor. Said Hiller: "Until you do it, you don't know the feeling - to know that someone is trusting you with a part of themselves."
Second, third chances