Four years ago when Corey Joiner learned he was a bad match to donate a kidney to his friend, Denise Fowkes, he decided he still wanted to help.
He turned to the then still-fledgling concept of a paired kidney exchange.
Under such an arrangement, Mr. Joiner would donate to someone who was a match with him, and a donor associated with that person would give a kidney to Ms. Fowkes.
For more than three years, nothing happened, and Ms. Fowkes continued the grueling, four-hour-a-day, three-times-a-week dialysis treatments as she had since 1998.
"I was really getting discouraged," said Ms. Fowkes, 41, an Eat'n Park waitress from Export who was diagnosed with type 1 diabetes when she was 8.
She didn't know then that she and Mr. Joiner were about to become involved in one of the largest paired kidney exchange chains in the United States that would result in 12 people getting new kidneys over the last three months.
The chain would involve nine hospitals across seven states, with donors and recipients spread from California to New York and points in between -- including Allegheny General Hospital, where Ms. Fowkes received her new kidney in February.
"I was worried about ever receiving a kidney," Ms. Fowkes said Wednesday during a news conference at the hospital. "Then this past February I was going into the hospital, and I couldn't believe it was happening."
In the intervening years since she and Mr. Joiner first signed up to be part of a paired exchange, the concept became better publicized, more organized and technologically easier, thanks to advanced computer programs that could run all the possible match-ups and do virtual analysis of blood from potential donors and recipients.
Perhaps the biggest change, though, was a 2007 federal law that said that paired kidney exchanges were not, in essence, paying something of value for an organ, which would make it a violation of the National Organ Transplant Act.
The new law "changed everything. It clarified the legality," Dr. John Friedewald, chairman of the kidney paired donation work group for the United Network for Organ Sharing, an organization that oversees the nation's organ and transplant network, said in a phone interview.
As a result, the number of paired kidney exchanges grew exponentially, from just 74 transplants in 2006 when Mr. Joiner first offered to help Ms. Fowkes, to 304 last year, according to UNOS.
A year ago, Allegheny General, where Ms. Fowkes was receiving her dialysis treatment, joined three of the nation's paired kidney exchange consortiums, which share information on patients and donors, increasing the number of potential matches.
"It's a numbers game," said Tom Mollo, executive director of the National Kidney Registry in Babylon, N.Y., a consortium of 50 transplant centers in 23 states, which organized the 12-pair exchange. "The more people you have in the pool, the more transplants you can do and the more people you help."
Since the first recorded paired kidney exchange was done in the United States in 1994, UNOS data shows a total of 845 paired kidney exchange transplants completed by the end of 2009 -- 77 percent of them in the last three years alone.
Experts believe if there were one national, paired kidney exchange program that put all of the potential donors and recipients from all of the 241 transplant centers in the United States into one big pool, up to 3,000 more live kidney transplants could be done -- with live kidney donations being a crucial part of the issue.
Currently, about 84,000 people are awaiting kidney donations in the United States and about 17,000 of them receive kidney donations annually, but about 55 percent of those are from deceased donors. Recipients from live donors -- as in a paired exchange program -- tend to live longer, healthier lives than those who received kidneys from deceased donors.
"We need a national program," said Laurie Reece, executive director for the Alliance for Paired Donations, a consortium based in Maumee, Ohio, that represents 80 transplant centers in 30 states. "I don't see the huge numbers happening for awhile, but I hope we will soon because it will save lives."
That could happen soon.
Last year the U.S. Health and Human Services department directed UNOS to oversee a pilot program to see if a national paired kidney exchange program was possible.
Later this year it expects to get the pilot program up and running by linking four consortiums, including the Alliance for Paired Donations, into one big pool. If that goes well, a year later, UNOS could propose a truly national program.
"The idea of that has been around for a long time," said Dr. Friedewald, a transplant nephrologist at Northwestern University in Chicago. "And I always tell patients, 'I don't know why it took them so long to come up with the idea, but I'm glad they did.' "
Because about 10 percent of people awaiting kidney donations die annually, Ms. Fowkes had long been beating the odds.
Within just a few months of being registered with the National Kidney Registry, a compatible donor was found for Ms. Fowkes, and a recipient for Mr. Joiner.
But it didn't stop there.
As part of that chain, Ms. Fowkes received her new kidney from a woman in New Jersey, and Mr. Joiner's donated kidney went to another woman at Allegheny General, Kimberly Wagner, 43, a grade-school teacher from Shaler. Ms. Wagner's paired donor, a childhood friend of hers from Maryland, donated her kidney to someone in California.
Other donors and recipients came from Utah, New York and Virginia in a chain of 12 donations and transplants that began Jan. 21 at Montefiore Medical Center in New York, and ended Feb. 18 with a final transplant at UCLA hospital in California, Mr. Mollo said.
Ms. Fowkes said she didn't even know about paired kidney exchanges when Mr. Joiner first offered to help her, but now, she said, "I think it's a wonderful thing. It gave me my life back."
Sean D. Hamill: firstname.lastname@example.org or 412-263-2579. First Published April 15, 2010 4:00 AM