1492239502389 - Kiwi on the brink is a recipient of NZ’s first three-way kidney transplant

Kiwi on the brink is a recipient of NZ’s first three-way kidney transplant

Penny Mulder gave one of her kidneys to a complete stranger to save her mother’s life. 

She would have given it to her mother, Christa Mulder, who had end-stage renal failure, in a heartbeat if she could – but they weren’t a match.

So instead, a team of medical professionals hatched a plan to give Penny’s kidney to a stranger, and transplant a kidney from another stranger into Christa.

Her near-fatal, life-long battle with underdeveloped kidneys came to an end on October 10, 2016, when she became a recipient of New Zealand’s first three-way kidney exchange.

READ MORE: * Minister welcomes NZ’s first three way kidney exchange * Families veto organ donation * Shake up of donor system

Six people went under the knife in the ground-breaking operation; three patients in need of a new kidney, each with a “heroic” family member giving one of theirs up for donation.

The exchange is being hailed as an “exciting new approach” to combat kidney disease in New Zealand, but Christa, 48, from Botany Downs in east Auckland, describes it as her final “miracle”.

“If it weren’t for the exchange, it would have been a very long time on dialysis for me.”

With tears in her eyes and her voice wavering, she recounted her “year of miracles”, having come back from the brink of death several times.

It started a couple years ago when the kidney she had received from her first transplant at 23 became blocked, giving her the tell-tale pains in her stomach.

In early 2016, Christa went in for a laparoscopy in search of the problem, but instead caught a virus from the hospital room that saw her condition deteriorate to the point where she slipped into a coma for a week.

She pulled out of the coma and was placed on dialysis, but her kidney function was so low that her 60kg frame eventually swelled up to 80kg with excess fluid – even though the stress of dialysis was making her lose body fat.

Eventually she became so swollen that fluid flooded her abdomen and lungs, giving her extreme breathing difficulties.

After another trip to the hospital and countless tests, the mother of three was sent home to recover.

But recovery wasn’t on the cards – just a steady deterioration.

Life was bleak for Christa, her husband Johan and their children, but it was 24-year-old Penny who felt it the most.

“She’s been wanting to donate me a kidney for years and years, she had always been the most caring, generous soul,” her mum says.

“It’s the little things; she’s the girl who’s always saving for birthday and Christmas presents, or making sure you’re buckled up before driving.”

Among the discomfort, Christa found unusual relief lying next to the gas heater in her house, so for the better part of a year she slept on a mattress in the middle of her living room.

“It brought me the strangest comfort down there on the ground, it was just the right type of heat, I couldn’t sleep anywhere else,” she says.

Then she got word of a potential three-way kidney transplant.

Her hopes had already been raised and dashed twice when one of the final rounds of tests revealed the donor kidney wasn’t compatible with her body. 

So with every new test she passed leading up to the three-way transplant, she allowed herself to become more and more hopeful.

“It was amazing knowing that there was a kidney out there for me but I was nervous as hell praying that every test would come back positive,” Christa said.

And Penny was right at her side, asking how soon she could donate.

“She would nag the doctors about ‘if she could do it’ then ‘when she could do the tests?’ and finally, ‘how soon she could donate?’ – she phoned them almost daily after we first found out about it.

“It was an amazing sacrifice, I am so incredibly grateful to her.” 

On October 10, 2016, the time for the transplant finally arrived.

Over 12 hours and in three cities, five surgeons and countless support people ensured three people in need of kidneys got them, the exchange was a success.

“It’s the most amazing feeling, I have the most energy everyday, I’m like a puppy – I just want to do everything,” said Christa of her new life.

Co-ordinators told Christa the rest of the donations and operations had gone well and that her daughter’s kidney was taking to its new body.

But organ donations are an anonymous process in New Zealand for privacy reasons, so Christa never got to thank her donor personally but said she owes them her life.

And equally, she is grateful to her daughter, whose willingness to donate a kidney even to a stranger, meant she got her life back.

WHAT IS A THREE-WAY KIDNEY EXCHANGE?

The process takes three incompatible donor and recipient pairings and matches them with each other to allow a transplant to take place.

Pairing one would receive a kidney from paring two and give one to pairing three. Pairing two would get a kidney from pairing three and so on.

The logistically challenging set of operations starts with the kidney removals in the morning, organ transit around midday and the transplants into the recipients’ bodies by evening. 

The 12 hours worth of operations is  just the tip of the iceberg –  it was preceded by months of paper work, testing and liaising with families.

Ian Dittmer, the physician who supervised the three-way transplant, said it was very hard to find a donor that matched Christa, due to her extremely high antibody count meaning that only 10 per cent of the population could potentially donate to her.

“One of the biggest hurdles to finding compatibility is having to make sure the person who is getting the kidney doesn’t have any antibodies to the donor … otherwise the recipient’s body will start to attack the new organ.

“Antibodies are proteins that your body makes, normally to fight infection. These antibodies attach to the kidney cells or the liver cells and attack it and try and get rid of it.”

Christa has an extraordinarily high amount of antibodies that came from her previous kidney transplant and subsequent blood transfusions, Dittmer explained.

Even though the odds were stacked against her they were able to find a match.

“It’s quite exciting when you can ring those people up and say ‘we’ve got a kidney for you’,” says Dittmer.

While New Zealand had done “quite a few” two-way kidney swaps since the introduction of the procedure in 2012, this was the first three-way exchange, he says. “Three-way swaps are definitely the way of the future for people who are hard to find kidneys for.”

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