Nearly two years after the world's longest chain of kidney transplants started with a single donor from Michigan, an article detailing the Toledo-coordinated approach to generate more and better matches appears today in the New England Journal of Medicine.

University of Toledo Medical Center transplant surgeon Dr. Michael Rees, medical director of Maumee-based Alliance for Paired Donation Inc., said the article should give critical exposure to a new method aimed at increasing life-saving kidney transplants.

Using software invented by Carnegie Mellon University computer scientists including Dr. Tuomas Sandholm, the method is based on an altruistic donor who voluntarily gives a kidney to anyone in need, starting a chain-reaction among recipients with willing but incompatible donors who in turn donate to another person.

Previously, the Alliance found that without any altruistic donors, only one two-way exchange could be made among 100 patient-donor pairs, Dr. Rees told the Pittsburgh Post-Gazette in 2007. But when it included altruistic donors, it was able to create chains of transplants, some of them involving as many as four donors and recipients.

So far, more than 1,200 people have registered on the Alliance's Web site -- www.paireddonation.org -- with more than 250 being potential altruistic donors, Dr. Rees said. He created the Alliance to help people with willing donors who end up not being matches by lining them up with other recipients and donors, either in paired exchanges or through a chain started by an altruistic donor.

Dr. Sandholm has told the Post-Gazette he has high hopes for kidney exchanges, especially if the current voluntary networks can eventually be combined to create a national database, which would increase the odds of good matches.

"If you look at the trends in the [United States]," he said, "there are two possible solutions to the kidney transplant problem. One is that a whole bunch of people will start donating their kidneys upon death, and there's nothing suggesting that's going to happen.

"It's a pretty grim situation. Supply doesn't meet demand and the imbalance keeps growing. So kidney exchange is really the only way to do it."

Professionals at Boston College, University of Cincinnati and Harvard University as well as Carnegie Mellon helped make the Alliance's chain approach possible by developing computer models and software identifying the best possible matches.

Matt Jones of Petoskey, Mich., started the Alliance's first altruistic chain in July 2007, by donating a kidney to an Arizona woman. The father of five told The Blade he has long been a blood donor and became interested in kidney donation after seeing a television program.

The second recipient in the chain, Angela Heckman of Toledo, received a kidney from the Arizona woman's husband soon after. And her mother, Laurie Sarvo, also of Toledo, donated a kidney seven weeks later to a recipient in Columbus, the third in the continuing chain that has had an 11th donor ready for nearly a year.

The Alliance's second chain, started by altruistic donor Tracy Armstrong of Maumee, has resulted in five kidney transplants so far. Four other chains have been started, Dr. Rees said.

Still, only about 10 percent of altruistic donors registered with the Alliance have been evaluated, a process that costs $3,000 to $5,000, Dr. Rees said.

"I hope the word gets out to people with kidney failure so they will register on our Web site and we can help them," Dr. Rees said.