The greatest gift he never asked for

September 6, 2009

Doctors save patients every day. Rarely, is it the other way around. Even more rarely does a patient save the lives of two people she barely knows.

The bulky bandage caught Kim Myers' eye as she waited in a sedated fog about to undergo foot surgery in December 2007.

"What is that?" she asked her doctor.

Dr. Jay Schnitzer didn't like talking about his medical problems with patients. It seems unprofessional. He also feared that patients might be reluctant to have a sick doctor treat them.

Jay Schnitzer and Kim Myers

But the doctor didn't like lying to patients either.

"I have a slight kidney problem," he told Myers as the anesthesia kicked in.   

For nearly four decades, the Lower Southampton podiatrist has kept patients on their feet. At more than 300 pounds and diabetic, Schnitzer didn't let his size slow him down — until three years ago.

That's when he developed an irregular heartbeat as a result of a blood clot in his heart. Surgery removed the clot, but his kidneys failed and he developed end-stage-renal disease.

For more than two years, Schnitzer, 61, was tethered to a kidney dialysis chair. After an eight-hour work day, he'd spend another 31/2 hours undergoing the lifesaving treatment that removes toxins from the blood. The three-times-a-week regime left him exhausted physically and psychologically.

His name was placed on the waiting list for a cadaver kidney. That list has more than 78,000 names in the United States. A total of 16,628 kidney transplants were done in 2007. Every year, one out of every five dialysis patients in the U.S. dies.

Schnitzer likely faced a five- to eight-year wait for a cadaver kidney.

Pretty depressing, but the doctor didn't let it stop him. He continued working and performing surgery part time, though it required taking extra safety steps. If bacteria entered the dialysis port in his upper chest, it easily could have led to a dangerous infection.

Sometimes, he wore a Hazmat suit in the operating room. More typically, he'd protect the port with sterile bandages sealed with a clear membrane, which often left a noticeable bulge peeking out of his low-cut scrub shirts — like the one that Myers noticed.

DO YOU UNDERSTAND?
Two weeks after her surgery, Myers, 49, returned to Schnitzer's office to have the stitches removed. It was their fourth face-to-face meeting.

In other post-op visits, Myers had asked again about the nature of his kidney problem. Reluctantly, Schnitzer said he was on kidney dialysis.

His health crisis didn't disturb Kim. It inspired her.

"I want to test for you," she said.

She was offering him a kidney.

Stunned, Schnitzer's hands started shaking. Tears filled his eyes.

"Do you understand what you are saying?" he asked.

Yes, Myers said. She already had talked it over with her family doctor.

Her offer deeply touched Schnitzer, but he didn't take it seriously. How could he? He graciously declined.

But Kim kept pushing.

"I don't think he really believed me," she said. "I think he thought I was being polite,"

The Bensalem mother of four was familiar with the physical, emotional and financial hardships of dialysis. Her mother-in-law was undergoing dialysis when they met. She later died.

Myers has also experienced the kindness of strangers, when she was a struggling single mom trying to make a better life for her family.

Schnitzer is one of those rare people, Myers said. He would walk into a room and fill it with light, even as he was cheating death.

"I don't mean to sound morbid," she said. "He just walked around like he was life itself."
At every follow up visit, she kept bugging the doctor to let her get tested as a potential donor.

"My mom said, "Test me, too,' " Myers recalled.

A BIG DECISION
If he was going to consider transplant surgery at all, Schnitzer knew he needed to lose at least 100 pounds. He underwent weight-loss surgery in June 2008 and dropped 85 pounds in four months. He has since dropped more than 130 pounds.

When Myers saw the slimmed-down doctor, she asked him again, did he want her kidney?

If she really wanted to do it, Schnitzer did, too.
What followed were a series of 18 medical tests, including blood work, tissue typing, colonoscopies, and a mammogram for Myers. Living donors must be in superhuman good health, said Joell Alter, a physician liaison with the Temple University Health System.

There are two critical factors with living kidney donations: blood type and antigen match. Antigens are genetic markers on white blood cells that signal antibodies to help the body fight infection.

Like 40 percent of the U.S. population, Schnitzer is O-positive. So is Myers.

After six months, the test results were in. They were not good.

Schnitzer and Myers were genetically incompatible.

Like three out of 10 kidney-transplant candidates, Schnitzer tested positive on a blood test called a 
Panel-Reactive Antibody — meaning the antigens in his blood were prepared to attack foreign tissue.

A patient is considered sensitized if the PRA is greater than 20 percent.
Schnitzer's PRA was 94. That meant only 6 percent of the world population would be a good antigen match reducing the chances of organ rejection, said Dr. John Daller, a transplant surgeon at the Temple University Hospital.

High levels of antibodies against foreign tissue make it harder to find a kidney; sensitized patients may wait three to four times longer for a compatible donor kidney.

This story could have ended there in a doctor's office at Temple University Hospital.

Instead, a more amazing story began.

"I'M GAME'
Temple University Health Systems, Schnitzer's alma mater, had joined a unique living donor program called the National Paired Kidney Donation Network. The organization uses a complex software program to find matches for incompatible living donor and recipient pairs.

The Paired Kidney Donation Network began in 2002 as a statewide paired donation consortium founded by kidney transplantprograms in Ohio.

Today, 140 of the 234 U.S. kidney transplant hospitals are part of its network, said Teresa Braun, the network's executive director. Locally, that includes Albert Einstein Medical Center, Thomas Jefferson University and Hahnemann University hospitals.

Would Myers and Schnitzer be interested in entering the network's database?

There are about 200 donor-recipient pairs in the registry; most are friends or relatives of the recipients, Braun said. At least 20 altruistic donors are in the process of being added to the registry. 

New software will allow the network to perform two-way and three-way matching involving up to four pairs of people at the same time, Braun said.

How it works is like this: Recipient A is compatible with Donor B and Donor A is compatible with 
Recipient B, so the two people who need kidney transplants can get them, if the donors exchange kidneys.

So if Myers agreed, she'd give her kidney to a complete stranger, whose incompatible donor would give a compatible kidney to Schnitzer. Myers also would agree to travel to where the other donor lived to undergo the surgery.

Will it mean Schnitzer would get a kidney quicker? Myers wanted to know.

The answer cemented her decision.

"I'm game."

SHE'S MY SISTER
The doctor and patient entered the database at an ideal time, right before a quarterly match run. 

About 48 hours later, a potential pair was found in Troy, Ohio, about 75 miles from Cincinnati, where 
Myers grew up.

The other donor candidate was a 28-year-old woman. The recipient: her 51-year-old mother, whose previous kidney transplant had failed.

All four donor-match candidates had O-positive blood types; Myers was a good antigen match for the Ohio mom. Equally as important, the young Ohio woman was a negative cross match with Schnitzer, meaning he would not reject her kidney.

About 35 hours before the transplant surgeries, Schnitzer spoke on behalf of the Paired Kidney Donor Program Network before doctors at the Gift of Life Donor Program, a nonprofit organ and tissue donor program serving the Philadelphia region.

Schnitzer said he believes the network will change the face of living kidney donations.

"The nightmare of dialysis is more than you can imagine," he said. "It [the paired program] is hope for people. Now there is another option."

Since the first network paired kidney exchange in 2004, about 55 others have been performed— more than half of them in the last 11 months, Braun said. Temple University performed its first paired kidney transplant in December. Schnitzer was the second one.

The twin surgeries took place June 25 in Cincinnati and at Temple University Hospital. Paired exchange surgeries not only take place on the same day, but at the same time. The first incision is made simultaneously in the patients because donors can change their minds up until anesthesia is administered, Braun said.

As surgery day grew closer, Myers grew more nervous. Her family supported her donation decision, though her husband was more scared than her. Myers says she never considered backing out.

"I knew I would do it," she said.

Yes, people don't understand how she could offer her kidney not to one, but essentially to two, strangers. To Myers, it made perfect sense.

"Wouldn't you? If you had the opportunity to save a life?" she recently said. "To be honest with you, I believe a lot of people out there who would do it, if they knew it wasn't that hard to do; knowing who it was made it even easier."

Two months after the transplant, Schnitzer's creatine level is considered normal, meaning his body isn't rejecting the new kidney. Follow-up visits to Temple Hospital have been reduced from three times to once a week. Every day, he feels stronger.

This week, he plans to return to seeing patients.

Schnitzer has already received a note and family photos from his Ohio donor; Schnitzer has written a long letter back, including his family photos.

Plans are in the works for the four to reunite in Ohio.

"I am thrilled. It's like my life is back," he said. "I have a second life and it is like, "Whoa. I am profoundly lucky.' Kim is truly my sister."

Jo Ciavaglia can be reached at 215-949-4181 or jciavaglia@phillyBurbs.com; twitter: @jociavaglia