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Paying it Forward with Kidney Paired Donation

Nurses Leading Innovation
January 15, 2017
Paying it Forward with Kidney Paired Donation

Transplant technology has advanced considerably in recent years, notably through the adoption of a transformative innovation called kidney paired donation (KPD), which pools living donors and recipients to increase the likelihood of matches. Susan Rees, RN, BSN, of Perrysburg, Ohio, has been involved in KPD for more than 16 years, first as a clinical transplant coordinator and now through her work with the Alliance for Paired Kidney Donation (APKD), a non-profit organization devoted to KPD.

NN: Can you share a little bit about your nursing career journey? Did you always know you wanted to be a nurse?

Susan: I actually started my career in social work, but when I was in my mid-twenties, my father was diagnosed with a brain tumor. I’ll never forget sitting in his hospital room one weekend and knowing that as his daughter, I could support him and I could love him, but I could only do so much. The nurses attending to him were able to provide him something I never could. I realized that was who I wanted to be. I immediately looked up nursing schools and enrolled in a two-year program for the next semester, which turned into a four-year BSN program.

NN: How did you make the transition to transplant coordinator?

Susan:  I began my nursing career in the pediatrics neonatal intensive care unit (ICU). I loved everything about being a nurse, but as I was starting out, my third child was born without an immune system. He was in and out of the hospital, infection after infection, so I took a leave from work. Once he was stabilized, I talked to a nurse friend who worked for an agency that places nurses in temporary positions and she asked me to accept a job as a hospital transplant coordinator for one month, even though I had no experience in the field. I was so intimidated, but it was the most gratifying position I’ve ever had. I’ll never forget my first transplant, and the joy of seeing a dialysis patient come in to my clinic doors with grey skin from toxins, and then seeing them leave with healthy, pink skin after their surgery. This role took me back to the experience with my dad, because I really was helping save a life.

NN: What led to the creation of APKD?

Susan:  In 2000, while I was still working as a transplant coordinator, I was approached by the Ohio Solid Organ Transplantation Consortium about working on a kidney transplant exchange program for the state alongside my husband, Michael Rees, MD, who is a transplant surgeon. With the help of his computer-programmer father, my husband designed the first prototype of a paired kidney donation matching system, which matched willing, but incompatible, donor and recipient pairs. Our first exchange involved a mother-son pair from Toledo and a married couple from Cincinnati, and it was just a great success. Soon enough, people from outside Ohio started asking to work with us. To take our program beyond state lines, in 2006, we established APKD as one of the first national, non-profit organizations dedicated to kidney paired donations.

NN: How has APKD evolved since its inception?

Susan: We started out just doing two-, three- and four-way transplant swaps. However, in 2007, we received a call from a gentleman who had heard about our organization and wanted to donate to a stranger. We thought about this proposition of “paying it forward,”, and APKD soon performed the world’s first non-simultaneous altruistic donor chain. Now, donor chains are more common than traditional swaps that must be completed on the same day. To make this possible, APKD utilizes a Nobel prize-winning algorithm to match incompatible pairs, using a scoring rubric developed by a team of healthcare professionals to help find the best possible match.

NN: What is your proudest accomplishment (or favorite initiative) with APKD?

Susan: Last July, a doctor from Mexico called us about a unique situation involving a patient who had unsuccessfully received a living donation from her brother five years previously, due to some anatomy complications that prevented the transplant from taking place. She was in a deep depression because of her condition. Because patients with kidney failure don’t make red blood cells, she had received nearly 30 blood transfusions, creating antibodies against all of these donors, and her antibody level was at 94, which means 94 percent of donors no longer matched her. Although she had a cousin who wanted to be part of a paired exchange program, Mexico doesn’t currently have one. What we would have liked to do is have her transplant done in Mexico by flying in the donated kidney, but we couldn’t just ship an organ outside of the country. We worked tirelessly with both governments, with TSA and with Delta, and eventually we were able to fly both the patient and her cousin to the United States to complete both transplants in Ohio. Through my church, we found a family to host them for their five-week stay, and the patient received a kidney from a woman in Wisconsin who was paying it forward after her son received a transplant through APKD. It was such a beautiful celebration of life, and I actually just got back from Mexico, where we celebrated with the patient and her family at their home for three days.

NN: What role do nurses play in APKD-led transplants?

Susan: Nursing is such an amazing profession. We work with more than 70 transplant centers in 27 states, which means we rely on each nurse coordinator to help with the extremely complicated logistics process needed to make each match possible. I couldn’t be more proud of the transplant community in America for pushing this forward. It is such a gift that people are willing to donate, and that so many people are willing to offer their time to save a life.

For more information on paired kidney donation, visit the Alliance for Paired Kidney Donation website. To learn more about the role of a transplant nurse, visit

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