Section: Saint Barnabas Medical Center News

His Brother's Keeper


Tom and David Darby are as close as two brothers can be. Fifty four-year-old David calls Tom, 61, "the ideal brother. He taught me to play baseball. He bought me my first mitt. He took me to my first bar. My brother means the world to me." That bond has grown even stronger recently, as Tom's kidneys failed.

Tom, an insurance consultant in Long Branch, is a divorced father of two and grandfather of one. A history of hypertension and obesity led to his first kidney transplant, in 2004. David offered to donate then, but was not a match. "It was a real letdown that I couldn't help him," says David, a retired Wall Street IT specialist who recently moved to Myrtle Beach with his wife, Linda. Their brother-in-law, Nils Eliason, however, was a match, and that transplant worked well for about six years, until it too failed. From 2010 through 2013, Tom was on dialysis and waiting for a donor. Fortunately, a lot had changed in renal transplantation since 2004, the most significant being living donor exchanges.

New, minimally invasive surgical techniques such as laparoscopy, combined with better communication among donor registries, allows for incompatible donor-recipient pairs, like Tom and David, to enter databases of similar pairs. Computer programs sift through all the pairs and find matches among chains of people, so that David could donate to someone else, and Tom likewise would receive a kidney from an anonymous match.

"Unbeknownst to me, Dave found out about the program," Tom says. "He told me, 'We should do this.' I was apprehensive about getting a second kidney. I didn't want someone to sacrifice with the potential that I could lose it again. But my brother and everyone else around me were gung-ho about it, so I agreed." "We have the infrastructure— the ability to communicate rapidly, to transport organs safely and to find matches quickly." -Shamkant Mulgaonkar, M.D.

In 2006, Barnabas Health created New Jersey's first and only living donor institute. "Living donation is its own specialty, and we wanted to streamline the services for living donors," says Marie Morgievich, director of the Saint Barnabas Living Donor Institute. "The institute brings all our expertise into focus. We were the first hospital in the country to do this."

A decade ago, exchanges were impossible, says Shamkant Mulgaonkar, M.D., chief of the renal and pancreas transplant division. When unmatched pairs came in, "We sent these people home and said, 'We are sorry,'" he adds. They were put on transplant waiting lists, but because demand far exceeded supply, patients spent years waiting; many never found a match in time.

The advent of minimally invasive surgery, in the late 1990s, allowed people to donate a kidney more safely and helped living donation become more common. "It actually started around this area," Dr. Mulgaonkar says, of the tristate region. "It took off because we have the infrastructure—the ability to communicate rapidly, to transport organs safely and to find matches quickly." Chains can run as small as two pairs. "The biggest chain ever was 65 people, I believe," he says.

The Darbys' chain "was started by a doctor who decided she wanted to make a difference," Tom says. That donation led to the creation of a chain of people from all over the United States. The Darby's got their call in October of 2013.

"For me, donation was easy," says David. "There was no pain at all. The most discomfort was from the catheter." He was discharged a day after the surgery and then "hung out with [his] brother, who left a few days later." After donation, the remaining kidney enlarges to compensate, according to Dr. Mulgaonkar, and within a week donors have between 85 and 95 percent of normal kidney function.

Tom's response was even better. "The surgery went phenomenally well," he says. "The outpouring of support and love was incredible. And my partner, Christine Vasile, was there for me through the first rejection, dialysis and the new transplant. She stuck with me."

But the best outcome may be the time he now gets to spend with his 4-year-old granddaughter, Kayla. "I pick her up from daycare every afternoon and we have a great time," Tom says. "We go to the park; she loves the swings and playing tag. I am not up to running yet, but I'm getting there. We go to Barnes & Noble, and I read books to her. She makes it worthwhile to have gone through all this."

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