A friend, indeed

By Beverly Creamer
Advertiser Staff Writer

Kehau Kaylene Keoho was groggy from the surgery as she lay on a gurney in the St. Francis Medical Center recovery room last week. But when another gurney rolled past, she raised her hand to wave at a familiar face. An equally groggy Herman Nii waved back as he was wheeled into the isolation recovery room across the hall. "I cried," said his elder daughter, Bonnie Nii Chang.

At St. Francis Medical Center, Herman Nii recovers after receiving a kidney donated by Kehau Keoho, right. At center is Dr. Whitney Limm. Jeff Widener • The Honolulu Advertiser

It's the beginning of a new era in kidney transplantation in Hawai'i, and that could mean greater hope for the 240 people on the kidney transplant waiting list.

Transplant surgeon Dr. Whitney Limm, head of the Renal Transplant Program at St. Francis, brought the surgical technique to Hawai'i. But, he said, the new matching techniques wouldn't work without two medications that within the last few months have been shown to prevent rejection by the recipient's body, even when the tissues don't match at all.

Limm, who performed the surgery on Nii with a transplant team that included Dr. Alan Cheung and Dr. Linda Wong, explained that the new surgery involves laparoscopy rather than a large incision; laparoscopy is surgery performed with instruments that pass through a narrow tube inserted in a small incision.

"With the laparoscopic approach, we've done seven transplants, and three were done with 'emotionally related' individuals," said Limm.

With conventional kidney transplant techniques, recovery takes six weeks, during which time donors are unable to return to work, said Limm. With laparoscopic surgery, the donor can be out of hospital in three days and back at work within two to three weeks.

"Many donors are working. They have children, and other obligations, so I think with this new surgery more people will be willing to donate," said Limm.

At the same time, two new medications — Cellcept and Simulect — have been added to the arsenal to prevent the rejection of the new organ by the body. "In the past we've been more insistent on HLA — human leukocyte antigen — matching," said Limm. "These are white blood cells and antigens are proteins on the white blood cells. With a living, related donor there's usually three of the six matching. But with a living, unrelated donor, many times it's zero matches out of six." But the new drugs make such matching less necessary.

"So there's a trend developing. Because of the availability of this approach, and because of the better medications ensuring the success of the transplant ... that will encourage more people to proceed with donation," said Limm.

It's already happening.

In the next few weeks, a middle-aged woman will donate one of her kidneys to a friend from church who has a young family.

"The donor is in her 40s and the recipient is in her late 20s or early 30s," said Limm. "The fellow church member saw that the mother was started on hemodialysis and it had limited her ability to care for her children."

Even though Keoho and Nii aren't related, the two families have been close for years and there are strong emotional bonds between them. "When she woke up from surgery the first question she asked was 'How is he?'" said Limm.

"Uncle Herman," 66, has been both a father figure for Keoho, whose own father left when she was very young, and a surrogate grandfather to her 9-year-old daughter, Kelsey. Keoho is a special education teacher and a single parent, and Herman Nii has always been there to pick up Kelsey from school when Keoho couldn't, and to care for the girl like a grandparent.

"He's a good man, and if this can help him live 10 years longer, I'm going to do it," Keoho told her friend, Stacie Nii, Herman Nii's daughter.

Herman Nii was incredulous, and so grateful his eyes clouded with tears. "I said I'm too old, but no, she insisted she give me one," he said, from his St. Francis Medical Center bed four days after the surgery.

"I'm very fortunate, I have good friends," said Nii. "My daughter said I had four people who offered me (their kidneys.)" Because there is diabetes in the family, his own daughters were ruled out as potential donors. And by incredible happenstance, Kehau and Herman matched three out of six markers, further insuring the likely success of the transplant.

Keoho and Stacie Nii teach together at Waipahu High School where Keoho also coaches volleyball. "We're all good friends," said Herman Nii. "They hang out my house a lot ... We've always been like that."

But the elder Niis haven't always understood the importance of organ donation.

"When I was going to college, I brought home an organ donor card and had to explain to them," said Chang. "They were real adamant about not doing it. My mom said, 'Oh, they're just going to take your organs ...' But through the years, they've understood more and more about donation."

And the medical community is learning more about how to support those who donate organs.

The National Kidney Foundation of Hawai'i is in the process of adopting a Living Donor Paid Leave Policy allowing 30 days of paid leave for any of the organization's employees who donates a kidney or other life-saving organ or tissue. The local policy follows the same action by the nation affiliate.

"What we're trying to do overall is remove the barriers for transplantation," said Glen Hayashida, chief executive officer of the National Kidney Foundation of Hawai'i. "Not only do people have to take time off, but that's lost income. So if we can remove those barriers, that's an incentive."

St. Francis Medical Center, too, is in the final stages of adopting a similar policy, offering up to six weeks of paid medical leave for its 1,200 employees if they choose to donate life-saving organs.

"We're waiting for final approval from the corporate office, but we're sure it's going to happen," said Paul W. McFall, manager of the Transplant Institute of the Pacific at St. Francis. "It's an obvious thing to be able to provide to our employees."

St. Francis is the first Hawai'i hospital to move in this direction, but McFall said the hope is that other medical facilities and private companies will follow.

"As we emphasize this, we'll see more and more people come forward to do this, especially if they see it's not going to be a financial burden to do so," he said. "If we're able to eliminate that factor, it's logical to assume there will be an increase in donations. It encourages people to look into that."

In the Legislature, Sen. Avery Chumbley, D-6th (E. Maui, N. Kaua'i) proposed a bill to allow paid leave for bone marrow donors. It died, and Chumbley says it might be a better idea to start by passing legislation for government workers before moving to the private sector. But first, he admits, "we need to build a groundswell of support from the community at large."

Presently kidney and bone marrow transplants are performed in Hawai'i from living donors and through the after-death organ donor program. But in other transplant centers, resections of livers, lungs and even pancreases are also being donated and transplanted, said Limm. Hawai'i is not yet doing those procedures because they require a larger staff of transplant surgeons.