At first the encounter was as awkward as a double blind date. One man blushed a tomato-red color; a woman shifted in her chair and rubbed her hands together. But their discomfort was understandable. When David and Cristina Hunt faced Jennifer and Will Stoelting across a conference table at the Inova Transplant Center in Fairfax, Va., in June, the stakes were life and death.
Both women were suffering from kidney disease and knew that, unless they could find a transplant in the near future, they could die. But if the meeting went well, the four would gather again in a little more than a month, this time at Inova Fairfax Hospital. There doctors would remove one healthy kidney from each of the two husbands, then implant those kidneys into their ideally matched recipients. David Hunt's would go to Jennifer Stoelting and Will Stoelting's to Cristina Hunt. A perfect trade—and one of only a handful of so-called paired exchanges performed so far in which there is a double stranger-to-stranger donation.
Despite the initial jitters, that first meeting was a huge relief to Cristina, 31, and Jennifer, 27, both of whom had been on dialysis for years. "I just thought, 'Yea, I'm getting a kidney,' " recalls Jennifer, though, as David put it, "they could have been Hitler and Eva Braun as long as they had a kidney to give us." Indeed, just five weeks later, on July 18, in four simultaneous surgeries that spanned nearly eight hours, a 23-person medical team removed David's kidney and implanted it in Jennifer just as Will's was being given to Cristina. Even in the best circumstances "a living, unrelated kidney doesn't match perfectly, but luckily for us, all four procedures went off without a hitch," says Dr. Johann Jonsson, 48, director of kidney-transplant services at Inova, who operated on David. "These husbands gave these wives at least 10 additional years to live."
Of the 13,372 kidneys transplanted last year, more than 8,000 came from cadavers. Unfortunately for the 52,498 Americans now on waiting lists, cadaver kidneys remain functional for only about nine years, while ones from living donors can last twice that. Of course, if no relative yields a match, finding a suitable—and willing—donor presents a formidable obstacle. Paired exchanges are a new and promising alternative because they offer donors an incentive. In the case of the Hunts and Stoeltings it was a straight exchange. But in some cases a parent may also bump his or her own child to the top of a waiting list by serving as an anonymous organ donor. "Until fairly recently it was kind of unheard of to donate to a stranger," says Toni Webb, spokeswoman for the Washington Regional Transplant Consortium, one of the few organizations around the country that coordinate local paired transplants. "I think we're going to see a lot more of these exchanges."
For Cristina Hunt, the development came none too soon. Born in New York City to a bookkeeper whose husband left the family when Cristina was a baby, she met David, now a 31-year-old career Marine captain, in 1990 while the two were on separate vacations in Tijuana. They married three months later. Within a year the couple's first son, Christopher, was born. But in 1995, while pregnant with Jordan, now 6, Cristina was diagnosed with a form of nephritis, a chronic inflammation of the kidneys. In late 1998 she was put on dialysis, and in the years since she has spent nine hours every night hooked up to a machine to cleanse her blood.
Over time Cristina, a homemaker, developed several severe infections, and this year she nearly died twice, once from septic shock and another time from massive blood loss. Her doctors said a transplant seemed her best option. In January the Hunts were told that husband David would be an acceptable match. But in March, the day before the transplant was due to take place, both were devastated to learn that recent transfusions had caused Cristina to develop antibodies to David's blood, and he was no longer a possible donor.
Meanwhile in Manassas, Va., not far from the Hunts' Stafford, Va., home, Jennifer and Will Stoelting were experiencing much the same anguish. As a girl growing up in Pennsylvania, Jennifer, whose family has a history of kidney disease, developed high blood pressure and a succession of serious bladder infections, which later caused her kidneys to fail. While a senior at Manassas Park High School in 1993, she met Will, now 27, who works for an insurance company. The two, who have no children, wed in 1996. Throughout their marriage Will stood by Jen during her trips every other day to a dialysis clinic. Four years ago Jen, a medical receptionist, put her name on the national waiting list maintained by the Richmond, Va.-based United Network for Organ Sharing (UNOS). "But you never know if they're going to call you," says Will. "It could be 10 years."
The fateful notice came much sooner. Both Jennifer and Cristina were undergoing treatment at Inova, and nurses Masomeh Dhaliwal and Pat DiSanto, the hospital's transplant coordinators, realized that their respective blood types might mean a possible match. In May the Stoeltings received a phone message from DiSanto, who in measured tones announced that she might have found a match from a man whose wife also needed a transplant. "Jen freaked out," recalls Will. "But I knew it wasn't a sure thing." Happily, tissue typing, CT scanning and further tests revealed that both husbands were ideal donors, and the two couples met with doctors at a June briefing. "The doctors said, 'Okay, the date is July 18.' It was quick," recalls Will. Cristina remembers that news as "nerve-racking, like a prearranged marriage."
Just 12 hours after the surgeries, all four patients were recovering beautifully. Jennifer's mother, Dolores Adams, 50, visited David Hunt in his hospital room and thanked him for saving her daughter's life. "I gave him a kiss and said, 'You don't know what this means to me,' " she recalls. "He said, 'I'm glad to do it, ma'am, but I didn't know it would hurt this bad.' "
Despite their painful operations, both men were out of the hospital in three days and are now back at work. According to doctors, their remaining kidneys will simply grow larger to accommodate the added workload. As for their wives, the first three months after transplant are most critical, but both are back at home and expected to recover fully. Cristina, now free of her dialysis catheter, can look forward to swimming with her sons for the first time when she is fully healed. And Jennifer? She reports that she is simply "doing great."
In the weeks following their surgeries the couples have remained in touch and predict that the remarkable bond between them will last throughout their lives. In fact, Will's stepfather, Stuart Martin, 62, sees this as something more than a medical marvel. "These husbands gave their hearts to their wives when they were married," says Martin. "And they gave their kidneys to continue that love."
Susan Schindehette
J. Todd Foster in Fairfax
Your Reaction
