Transplant policy change could affect hundreds in S.C.
It will be harder for older patients to get kidney transplants

By WAYNE WASHINGTON | The State, South Carolina

A proposed change in national organ donation policy would make it more difficult for older kidney patients to get organs from donors who have died.

The proposed change — put forward by the United Network for Organ Sharing but still open for public comment — could have a significant impact in South Carolina, where more than half of the 831 people on the waiting list for a kidney transplant are 50 years old or older.

The idea is to make sure that jewel-precious kidneys go to those whose life expectancy surpasses that of the donated organ, from 14 to 18 years on average.

But the proposed change lays bare the type of wrenching questions that are likely to be asked more and more as the country gets older.

What limits, if any, should be placed on medical science’s increasing skill at extending life?  And is it wrong to extend life for an older patient if it means limiting options for a younger one?

“There is no good answer,” said Dr. Prabhakar Baliga, the chief of transplant surgery at the Medical University of South Carolina, the state’s only organ transplant center. “I am having an extremely difficult time with this.”

Those in the transplant community say there is a solution of sorts, a way out of the moral maze.

It starts with a simple mathematical equation.

‘Three to five years didn’t look very hopeful’

Two minus one equals one.

As a former educator and a man of faith, Bill Hynds has come to view God as the original and most brilliant mathematician. Math in nature is a passion for the 83-year-old Hynds, who shares a neat ranch home in Columbia with Anne, his wife of 57 years.

There is a special beauty, Hynds believes, in the ordered and descending ridges of a pineapple or pine cone. And a spider web in spring is not merely a harbinger of a new season; it’s a geometric marvel.

Two years ago, an old mathematical truth — two minus one equals one — saved Bill Hynds’ life.

In spring of 2008, Hynds wasn’t feeling well. He was having trouble breathing, went to the hospital and was diagnosed as having pneumonia. It was a serious diagnosis, particularly for a man of his age. When Hynds failed to respond to medical treatment, doctors ran a series of tests and discovered why.

“One evening, a team of doctors walked in and said, ‘Mr. Hynds, are you ready for dialysis?’” Hynds recalled. “I said, ‘The way you said that, I guess I better be.’ They said, ‘Yes, sir. Your kidneys have failed.’”  Neither Hynds nor his doctors ever got a clear reason for the failure of his kidneys. He went on dialysis, which, for him, was only partially effective.

Anne Hynds could only watch as her husband switched from one type of dialysis to another and still got limited results. “I felt so helpless,” she said. “I just figured he was going to die because he was not getting enough of the impurities out with the dialysis. It was very frustrating.”

Anne Hynds wanted to donate an organ to her husband but was told she was too old. And because doctors did not know what caused the kidney failure, they could not be sure it wasn’t something that ran in Bill Hynds’ family. That meant getting an organ from one of his relatives was out.

So, Bill Hynds underwent an exhaustive round of medical testing and awaited word on whether he could be placed on the transplant waiting list.  Getting on the list did not offer Hynds the same type of hope it offers a younger person. The wait, he was told, is typically three to five years.

And Hynds was 81 years old.

When he got a letter on Friday, July 17, 2009, congratulating him for being placed on the list, Hynds said he was happy but not overjoyed.

“I didn’t even tell Anne about it for a little while,” he said. “I thought, ‘That’s nice. But three to five years didn’t look very hopeful.’”

Still, Hynds eventually shared the letter with his wife and, that Sunday, offered it up to his fellow parishioners at Bethel United Methodist Church as a blessing.

‘It was in God’s plan’

Marian Scullion knew Bill Hynds had been sick.

She grew up in the neighborhood where the Hynds live. She knew and was friends with the Hynds’ children. At one point during her childhood, Bill Hynds was her Sunday school teacher in church, and she had taken piano lessons from Anne Hynds as a high school student.

That July Sunday in church, what Bill Hynds offered up as a blessing, Scullion heard as a calling.

“I said nothing about a living donor,” Hynds said. “I said nothing about three to five years. I did not ask her.”

But Scullion, a 49-year-old teacher, already had made up her mind.

“She said, ‘Bill, I’ll give you a kidney,’” Hynds said.

As church ended, Scullion’s husband, John, saw the Hynds and his wife, and thought something was wrong.

“The three of them are crying,” he recalled. “I said, ‘This is not good.’”

John Scullion asked his wife what was wrong.

“She said, ‘I’m going to give Bill a kidney,’” John Scullion said.

Sitting on the couch last week in the living room of the Hynds’ home, Marian Scullion looked down sheepishly as her husband recalled that day in church.

“I guess I should have discussed this with him,” she said, drawing laughs.

“I knew it was something I needed to support,” John Scullion said. “It felt so right. It was the right thing to do.”

From there, it was a whirlwind.

Marian Scullion had, months before that day in church, decided to eat better and exercise regularly. As she underwent testing to figure out whether she had two healthy kidneys, that decision paid off.

On July 30, 2009, Bill Hynds received another letter in the mail, and, this time, he was overjoyed. He tried to read from it last week, pausing on a line where the transplant team described what they learned about Marian.

“She is truly an amazing person,” Bill Hynds read.

Anne Hynds wiped away a tear. “They know her,” she said.

Marian Scullion sat on the couch, shaking her head in a vain attempt to toss back the praise.

“I do think it was in God’s plan,” she said. “I had a feeling things were going to go well.”

They did.

On Aug. 5, 2009, Bill Hynds became the oldest recipient of a kidney from a living donor in MUSC transplant history.

That Marian Scullion had two healthy kidneys and was willing — eager, even — to give one away equaled a renewed life for an old, beloved friend.

Two minus one equals one. The solution? More living donors.

“There’s no way to say thank you,” Anne Hynds said. “There will never be enough ways to say thank you for life.”

‘Logically, I understand’

Bill Hynds walks a mile each day. Doctors have advised him to scale back his gardening — they want to limit his risk of infection — but he still enjoys crafts.

Most of all, he enjoys being with Anne and traveling to see his children and grandchildren.



Even though other older kidney patients could benefit from a new organ as he has, the proposed United Network for Organ Sharing change is a dilemma for him, too.

“I have mixed emotions,” he said. “Logically, I understand you want to get the most years out of a healthy kidney. I certainly understand that.”

Even if the policy change is adopted, kidney donors still would be able to direct their organ to anyone of their choice.

Few, however, make the choice Marian Scullion made.

In 2010, only 36 of the 144 kidney donors in South Carolina were living donors, according to figures from the U.S. Department of Health and Human Services. Since 1988, about 24 percent of the 2,623 kidney donors in South Carolina were living donors.

Organs from living donors last an average of about four years longer than organs from a deceased donor, MUSC’s Baliga said.

Still, the need for organs — from both living donors and from those who have died — is great.

National Kidney Foundation officials say that is why they support the proposed change.

“With nearly 88,000 Americans on the kidney transplant waiting list, we must maximize the limited pool of donor kidneys,” said Blakely Chikhliker, communications manager for the Carolinas region of the Kidney Foundation.

“Changing the way that kidneys are allocated could increase the number of years that donated kidneys function, lessen the need for re-transplantation and reduce the incidence of death with a functioning kidney.”

Baliga said it pains him when an older patient dies with a still-healthy kidney.

“The kidney is buried,” Baliga said. “Is that the best scenario?”

‘Life is precious’

But Baliga also was part of the team that operated on Hynds, and he said many older patients are more diligent about their health than younger patients.

Hynds, who recently celebrated his 83rd birthday, knows only that he has an opportunity he is determined to seize.

“Life is precious,” he said. “It doesn’t become more precious because you have more of it.”

He nodded in Marian Scullion’s direction.

“I would love to live into my upper 90s, so I can say, ‘Look what she did for me.’”

Waiting for a fresh start

As of Monday, there were 831 people in South Carolina on the waiting list for a kidney transplant. A look at how that list breaks down by age:

Ages 1-5: 1

Ages 6-10: 0

Ages 11-17: 5

Ages 18-34: 160

Ages 35-49: 236

Ages 50-64: 338

Age 65+: 151

SOURCE: The Medical University of South Carolina

Learn more about the proposed policy change at www.unos.org.

Learn more about kidney disease and find ways to help at www.kidneysc.org.