Greece and USA Complete First Intercontinental Kidney Paired Donation Transplant, International Press Conference at the Embassy of Greece

Medical history was made when a 31-year-old Oklahoma woman, Elizabeth Gay, altruistically donated her kidney to a stranger—a man living in Athens, Greece.  In return, the Greek man’s wife has now donated one of her kidneys to another person in Wilkes-Barre, Pa., completing the first intercontinental exchange and opening a door that potentially can save thousands of American lives, as well as others throughout the world.  To date, one Greek and four American lives have been saved and two more transplants are expected within weeks with a donor from Trinidad & Tobago entering the chain. The official announcement of this groundbreaking international chain was made today at the Greek Embassy in Washington, at a press conference hosted by Vassilis Kaskarelis, Ambassador of Greece.

“This joint effort of “paying it forward” confirms what a huge difference an individual can make,” said Ambassador Kaskarelis.  “With the world around us facing economic and political challenges, which at times seem insurmountable, such occasions reaffirm our faith in our humanity, and make us more optimistic and more hopeful about our common future. I truly hope that it is only the first of many such exchanges throughout the world.” 

In this remark, Ambassador Eric Rubin, Deputy Assistant Secretary of State for European and Eurasian Affairs stressed that this occasion illustrated the deep ties between the people of Greece and the United Stated. He also talked about his father in law, Dr. Richard L. Simmons who was a pioneer in kidney transplant surgery, and his late mother in law Dr. Roberta G. Simmons who co-authored with his father in law the first book studying the social aspects of altruistic donation of living kidneys.

At the news conference, Ambassador Kaskarelis introduced some of the donors and recipients, as well as doctors who have assisted in this cross-border cooperative process.

Expanding donor chains beyond U.S. borders can increase the potential donor pool exponentially, said Michael Rees, MD, PhD, Director of Transplantation at the University of Toledo Medical Center and CEO of the Alliance for Paired Donation, Inc.

Although 17,000 kidney transplants are performed annually in the U.S., there are still 96,000 people in "immediate need" of a transplant, Dr. Rees noted.  Donor scarcity makes the average wait for a suitable kidney five years.  Dialysis and related costs for patients awaiting transplant is $120,000 to $300,000 annually, while the typical cost of maintenance after a transplant is about $30,000 a year.  Beyond the financial costs, waiting for a donor takes an enormous physical and emotional toll on patients and families, since patients often undergo hours of dialysis daily and feel they are held hostage to the dialysis machines.

The international breakthrough announced today came as a result of the tireless efforts of Theodora (Dora) Papaioannou-Helmis, who had been working to save her husband's life by waging a relentless battle to change Greece’s transplant law—a law that stated that only a first or second degree relative could legally donate a kidney to a recipient in Greece. The law was intended to prevent a black market organ harvesting /selling system, but an unintended consequence was that it made kidney paired donation impossible since it requires strangers to “swap” kidneys.

The process known as “Kidney Paired Donation (KPD)” takes place when a donor who is incompatible with their designated recipient promises to donate their kidney to a stranger in order to enable their designee to receive a compatible kidney from another stranger. Most often KPDs are between designated donors but can also be started or facilitated by an altruistic donor.
The successful transplants were done at: The University of Toledo Medical Center, in Toledo, OH; Geisinger Wyoming Valley Medical Center in Wilkes-Barre, PA; Jewish Hospital Transplant Center in Louisville, KY; and Scripps Green Hospital in La Jolla, CA. Three more transplants in the chain will take place shortly at Piedmont Hospital in Atlanta and the University of Colorado Hospital in Denver, which will extend the intercontinental kidney paired exchange by transplanting a donor from Trinidad &Tobago.

Though paired exchanges have been taking place in the United States for more than 10 years, the idea of enlarging the donor pool by including other nations, thereby getting more Americans transplanted, has been problematic due to the variability in national transplant laws.  Dr. Rees explained that while in America it is currently not legal to transplant a living donor’s kidney removed at a transplant center outside the US, it is possible to have the international patient travel to America to participate.

As a result of Dora’s efforts and the keen insight of the Greek government to adopt new health laws regarding organ transplantation, kidney paired transplantation became legal in Greece. In essence, this allowed the Greek national health insurance system to pay for kidney transplants emanating from a paired exchange system within and outside of the country.  But a change in law was only the first step, Dora now had to find a compatible “swap” and in a country the size of Greece this would not be easy. Her only option was to enter herself into America’s paired exchange system and hope for a match. Time was running out for her husband Michalis.

Dora and her husband Michalis were the first internationals entered into America’s “Alliance for Paired Donation” recipient and donor pool. They then had the benefit of working with an organization that included eighty transplant centers in thirty states that work together in order to facilitate paired kidney donation.
Within weeks, the Alliance for Paired Donation found a chain of transplants that started with Elizabeth Gay giving to Michalis, Dora giving to a patient in Georgia, and the Georgia donor giving to a patient in Oregon.  A week before the proposed 3-transplant chain was to occur, the Georgia recipient became ill and was not able to participate. A search for another recipient who matched Dora was not successful—of all the patients in the APD pool, she only matched the Georgia recipient. This left the APD in a difficult position: should the chain continue, achieving only one transplant in which an American’s kidney is given to an international patient instead of an American? In addition, the team would have to trust an international donor to return to her home country and wait for a compatible match with an American patient to be found in the future.

To make this decision, Dr. Rees, called Dr. Dimitris Moutzouris, the nephrologist providing dialysis care for Michalis in Greece to explain the situation. Rees asked Moutzouris to interview Dora and determine her trustworthiness. Much was at stake, since if Dora reneged on her pledge the entire concept of “Pay it Forward” would be placed in doubt and the idea of establishing an international paired exchange system could be lost forever.  Dr. Moutzouris reported back that Dora could be trusted to "pay it forward" in the future.  Dr. Rees then contacted the American Embassy in Athens, Greece, and they also interviewed Dora.  With this assurance, Dr. Rees agreed to have Michalis and Dora fly to Toledo to meet them and make a final decision.  With the help of a Greek-speaking local restaurant owner, Dean Yakumithis, Dr. Rees interviewed the pair and agreed to trust Dora. And so the chain began.

Four months after her husband received Elizabeth Gay’s kidney, Dora kept her promise and returned from Greece.  Subsequently, four additional transplants have taken place with two more scheduled.

Dr Moutzouris, Dr Ioannis Boletis, Director of the Center of Nephrology of the Laiko Hospital in Greece and Mr Vasilis Athanasiou, lawyer of the Helmis family also took part in the conference today, as well as Ms Elizabeth Gay and other recipient and donors.

The Alliance for Paired Donation is an American non-profit organization (501-C-3) that facilitates kidney paired exchanges throughout the world.  Services are completely free for donors and recipients, and the Alliance assists with financial support for travel, food, and lodging when necessary.