Kidney Exchange Program Provides Life-Saving Donation Option for Jackson and Family

Katie Sutton learned that her son, Jackson, would need a kidney transplant during his first years of life. She immediately volunteered her own.

Testing revealed that the two were a match, and a date for the transplant was scheduled. Four days before the planned surgery, however, final compatibility testing showed that Jackson had developed antibodies that would fight against Katie’s cells. She was no longer a viable donor. She and her husband, Matt, were devastated.

“It was heartbreaking. But the [Cincinnati Children’s] team was amazing,” said Katie.

The team worked quickly to get Matt tested and simultaneously entered Jackson and Katie into the national kidney exchange program. Jackson was 2 years old at the time.

Kidney Paired Donation Helps Jackson and Other Transplant Candidates

The exchange program, also known as kidney paired donation, or KPD, provides transplant candidates with another option. It involves a wide range of donor and recipient pairs, who may live in different parts of the country. Through KPD, a donor (in this case, Katie) will donate their kidney to another recipient in exchange for a compatible kidney for their friend or family member (in this case, Jackson).

Born with end-stage renal disease, Jackson was on dialysis beginning at only two days old. A blockage in his bladder had caused urine to back up into his kidneys, destroying them. His care team in Indiana worked in close coordination with doctors at Cincinnati Children’s. Jackson would require a transplant—as soon as possible.

Thankfully, a match was found quickly via KPD, and the “kidney swap” provided the Sutton family with a much-needed, life-saving option for Jackson. The news of this match came at the perfect time: just after Matt learned that, like his wife, he wasn’t a donor match for their son. 

“I don't know much about our donor. I was told it was a female, and she was highly motivated,” said Katie. “So I can only imagine that she might have been doing the same thing I was doing.” 

KDP originally was created to overcome donor-recipient incompatibility issues. However, it also includes compatible pairs who participate in order to find a donor who is a better match to their paired recipient. A better match usually means the transplanted kidney will last longer and the recipient will require less immunosuppressive medication.

Fetal Surgery Expertise and Resources at Cincinnati Children’s

Today, Jackson is 3 years old and doing very well, thanks in part to the expert care he has received and the evolution of fetal surgery. At Cincinnati Children's, the fetal surgical program is a partnership between a small group of specialized pediatric surgeons and maternal-fetal medicine obstetricians.

Alexander Bondoc, MD, the pediatric surgeon who led Jackson’s successful surgery, considers this a primary difference between Cincinnati Children’s and other pediatric hospitals.

“I am not aware of any other children’s hospital in the country that offers the [same] expertise and resources for children with in-utero kidney disease,” noted Dr. Bondoc. 

But in order for Jackson and patients like him to benefit from the transplant surgery, important first steps are necessary, including being identified prenatally. Jackson was identified early—when Katie was 20 weeks pregnant—and as a result began receiving the early treatment and intervention he needed. 

A team of maternal fetal medicine obstetricians and fetal surgeons monitored Katie and Jackson while he was in-utero. They continued his care following delivery, including a tense three days in the pediatric intensive care unit (PICU), followed by time in the newborn intensive care unit (NICU). 

“While the time in the NICU is fraught with complication and critical illness, a significant number of these infants will survive, and [even] those with the most severe disease will grow and thrive to the point where they can undergo kidney transplant,” Dr. Bondoc explained. 

During his three months in the NICU, Jackson was given crucial time to grow before being released to go home in April 2020. After 28 months of being cared for at home, including a return to dialysis, Jackson eventually reached the size and weight requirements (22 pounds) for pediatric transplant. He was referred to Cincinnati Children’s, where both surgeries for Jackson and Katie were performed in October 2022, a few months after the originally planned surgery date. 

“I think from the time he was born, we'd been talking about a transplant,” said Katie, who, following the advice of Jackson's Indiana care team, wanted it performed at Cincinnati Children’s.  

A few additional surgeries were necessary, but Jackson is now thriving as the one-year anniversary of the transplant approaches. Follow-up blood work and a recent ultrasound confirmed there are no blockages to his kidney.

“We did a biopsy and that showed no rejection,” said Katie, who along with Matt, couldn’t be happier as they watch their 3-year-old son grow and his personality develop. He keeps them busy each day with his non-stop, little boy energy. 

“He loves being outside, playing with neighborhood friends,” Katie shared in a recent update. “He also loves popsicles—something new for him.” 

(Published September 2023)