March 6, 2007
When newborn Rachel McKey was handed to a Mississippi hospital worker on Dec. 12, 2005, wrapped in a wet T-shirt and nearly dead from hypothermia after being abandoned, she could not have known her longterm health would depend on the kidney of a woman who had waited four years to adopt a baby and the coordinated care of pediatricians and surgeons at the Tulane Center for Abdominal Transplant.
When Melissa and Phillip McKey first saw the baby who was to become their daughter, she was already in the Tulane Neonatal Intensive Care Unit with failed kidneys.
Melissa McKey sees baby Rachel as a blessing, despite the two months she lived at the Deming Pavilion next to Tulane University Hospital and Clinic while little Rachel spent her days receiving manual dialysis treatments until she was big enough to go home for peritoneal dialysis.
Now the McKeys make a weekly trip to New Orleans from Centreville, Miss., for checkups, to be sure the kidney Melissa donated to her adopted daughter is functioning well.
She is making excellent progress and in four to six weeks, according to pediatric nephrologist, Samir El-Dahr, chair of the Department of Pediatrics at Tulane, Rachel will be able to start playing with other little girls. Although the average wait for a kidney in Louisiana is five years, Rachel only had to wait until she was 2 and big enough for the surgery.
The family learned that Melissa could donate one of her kidneys -- but first she had to lose 50 to 60 pounds. While most people find the prospect of losing that much weight in a few months daunting, Melissa did not back down.
"When your child needs something and you can't do it because of your weight, it's embarrassing and humbling but we do what we have to. I don't know that I could ever lose weight like that under any other circumstances," says Melissa.
Surgeon Sandy Florman, who performed the transplant, says living donors like Melissa are amazing. "They know the risks and they take on a surgery they don't medically need to help someone else. They are the heroes," he says. Organs transplanted from a living donor last longer and are healthier, says Florman.
For example, a kidney from a live donor has a lifespan of 14 years on average, compared with only seven years from a deceased donor. Florman's partner and the chair of the Department of Surgery, Doug Slakey, performed Melissa's surgery laparoscopically.
A day after the McKey surgery, Florman and Slakey were back in the operating room with another pediatric case, a 2-year-old girl in liver failure who was receiving part of a liver from a cousin in her mid-30s.
Florman explains that the Tulane Center for Abdominal Transplant recently received a new United Network for Organ Sharing certification for performing living donor liver transplants. Nationally, there are only about 50 pediatric liver transplants from live donors performed each year, but Florman anticipates doing more at Tulane in the future as part of a collaborative effort with Children's Hospital.
"Our experience in the field and this certification make us the referral center of choice in this region for end-stage organ disease," explains Florman.
Florman says that one of the strengths of the center is the commitment to comprehensive care for transplant patients.
"We provide true multispecialty care. The transplant itself is only part of the process for our patients. We care for them before, during and after the transplant."
El-Dahr, who provides the follow-up care for Rachel McKey, agrees that the situation is unique. "I am able to see my outpatients with the transplant surgeon team in the same clinic, to have frequent meetings to discuss individual patients, and to project the same opinion and ideas to the families consistently."
Because Rachel will have to take anti-rejection medication indefinitely, El-Dahr will continue to see her in the clinic, eventually only every four to six weeks, to be sure her kidney is doing well. "I was struck by the extreme dedication of these parents to Rachel," El-Dahr says. "And I am continuously amazed by the superb surgical skills of our transplant surgeons."
The Tulane Center for Abdominal Transplant reopened 11 months ago and has performed nearly 200 transplants, a dozen of which were pediatric kidney transplants. Florman estimates they are approaching the same numbers of transplants that the center attained before Hurricane Katrina. One of the program's strengths, explains Florman, is the use of laparoscopic surgery, which allows donors to heal and return to their daily routines much more quickly.
Tulane University, New Orleans, LA 70118 504-865-5000 firstname.lastname@example.org