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Pioneering 'domino transplant' doctor changes lives

WASHINGTON, D.C. – Just after sunrise on a recent Friday morning, Dr. J. Keith Melancon had a large Starbucks coffee in hand and was gearing up for a long and busy day.

Melancon, 40, was getting ready to spend 12 hours on his feet in an operating room at Georgetown University Hospital where he is the director of the medical center's thriving kidney and pancreas transplant program. 

Talking to Melancon was Larry McPhatter, who himself was preparing for a big day – McPhatter was about to undergo surgery to donate one of his kidneys.

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"Don't worry we are going to take good care of you," Melancon told his patient, clasping his hand. "And once again, you're a hero my man, this is beautiful."

A kidney transplant is a surgery that places a healthy organ in a person who has suffered from kidney failure. Lots of kidneys are needed – more than 485,000 Americans are being treated for kidney failure, according to National Kidney Foundation. 

And the need is higher for minorities – due to high rates of diabetes, high blood pressure and heart disease, African Americans have an increased risk of developing kidney failure.  

In fact, out of the 85,458 Americans currently on the U.S. waitlist for a kidney transplant, 35 percent are black, according to the U.S. Department of Health and Human Services.  

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McPhatter was getting ready to donate a kidney to a total stranger – so that his wife Elizabeth, who has struggled through kidney dialysis three times a week for two years, could receive a new kidney from someone else.

They were just two people out of 14 involved in the recent kidney transplant chain at Georgetown and MedStar Health's Washington Hospital Center – most of the organ recipients were African American.

'Domino transplant'
The so-called "domino transplant" matched a group of incompatible donor-recipient pairs (a willing donor whose blood or tissue is not compatible with their loved one in need of a transplant) with other pairs of donor-recipients facing a similar challenge.

In domino transplants, a patient in need of a kidney brings a donor who is compatible with another recipient.  That donation allows the patient to receive another organ from someone else in the kidney swap.

Six males and eight females participated in this particular kidney swap over the course of four days – including two "altruistic donors" who actually knew none of the organ recipients.

Melancon was part of a pioneering team of doctors at Johns Hopkins Hospital in Baltimore who conducted the first six-person kidney swap in April 2008.

The swaps are made possible by using a process called "plasmapheresis," a procedure which filters the recipient's blood plasma, and makes the likelihood of the recipient's body rejecting the new organ less likely.

VIDEO: Kidney recipient: 'My life...will be better'

"The whole purpose of the plasmapheresis for these recipients is to remove the harmful antibodies and allow them to be safely transplanted," Meloncon explained.

It was at Johns Hopkins where Melancon, who is African-American, took a special interest in using the process to treat minorities, who have a genetic tendency to build up a lot of antibodies – making it more difficult for them to find a matching organ donor. African Americans in particular have a difficult time building up antibodies.  

During his time at Johns Hopkins, Melancon gained invaluable experience working with a wide variety of patients – many of whom had different blood types and high levels of antibodies that make organ rejection more likely.

"Over four years [at Johns Hopkins], I saw more of those types of patients than most doctors ever see in their lives," he said.

Melancon first became interested in transplant surgery during his residency at Tulane University in New Orleans.

There were two reasons for his interest.

"I actually did a research project when I was in med school on transplant patients. It was the first time I became exposed to young people in New Orleans who had kidney disease," he said. "A lot of them looked like me and were my age … It piqued my interest as to why they had renal disease," he explained, using another term for kidney failure.

The second reason was closer to his heart.

"I had a good friend, Bernard Hurst, one of my fraternity brothers who had kidney disease [and] wound up having a kidney and pancreas transplant."

Changing lives

It was in New Orleans where he met his wife, Lisa.

Melancon said he told her on their first date that he was planning to be a transplant surgeon and if their relationship was going to last, she would have to understand that. They have been married for 14 years now and have four boys between the ages of two and nine.

"My wife is a special person to understand how demanding this career is," he said. "If I am on call or not, even on vacation, I get calls about patients…Your family winds up making these sacrifices along with you."

While the hours are difficult – he sometimes works a 100 hours a week – Melancon loves what he does.

"I feel like the luckiest man alive because it really is a blessing. You get to change people's lives forever," he said.


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