Paying it forward: A cross-country kidney swap

“To know even one life has breathed easier because you have lived, this is to have succeeded.”

– Ralph Waldo Emerson

Four Canadians are living a bit more comfortably thanks to one anonymous Vancouverite whose recent selfless act of donating a kidney to no one in particular, triggered a nation-wide chain of events.

Dr. William Gourlay, surgical director, renal program, St. Paul’s Hospital, Vancouver, said there was one specific donor who inspired the cross-country kidney swap involving four donor-recipient pairs.

“I think the real story here is that of the anonymous donor,” says Dr. Gourlay. “This is a person who for no other reason than wanting to do good in the world, generated a chain that saw four people receive healthy kidneys.”

Typically, donor kidneys come from a deceased organ donor or from a living donor who donates directly to their loved-one. Some willing donors are found to be incompatible with their intended recipient but they may still donate through a “kidney swap” with another donor/recipient pair.

In this chain of events, one anonymous person from Vancouver decided to selflessly donate a kidney to a complete stranger. The donor was not linked to someone waiting for a match. There were no conditions of their loved one receiving a match. They were simply donating. No strings attached.

“Typically with these anonymous donors there is a long history of altruism and volunteerism in how they carry out their lives, and donating a kidney would be an extension of their life philosophy,” says Dr. Gourlay.

To some, this may sound simple. Most people have two kidneys, so why not give one away? But, Dr. Gourlay explains that there is more to it than just waking up one morning and deciding to donate one. Both organs must be healthy and strong and potential donors must go through medical exams and meet with surgeons, psychiatrists, social workers and family doctors before making such a permanent decision.

“The concept of swapping kidneys is not new; however it was the first swap in Canada, involving more than a pair of donor-recipients and involving multiple cities,” says Dr. Gourlay.

The organization of this kidney swap goes back over a year with the set-up of a registry where suitable, but incompatible donors are listed, in hopes of being a match for an unrelated recipient.

Donors and recipients are matched through the national registry by complicated computer algorithms. Even once a match is made, a team of specialists must confirm that the match is acceptable. When a chain of several donor-recipients is produced, planning also involves logistics such as transportation, timing and in some cases, multi-city teamwork. Dr. Gourlay was responsible for evaluating the Vancouver donor before confirming their participation and having them fly back east to donate to their match.

In this case, a donor flew in from Edmonton for the operation at St. Paul’s Hospital, while the donor’s spouse stayed in Alberta to receive a kidney from someone else at Edmonton’s University of Alberta Hospital. The relative of the kidney recipient at SPH flew to Toronto General Hospital to donate a kidney to someone there, and so forth. In a chain where pairs are not directly donating their kidney to their loved one, there can be a greater chance of someone backing out. Because of this, surgical teams agree to start the swap at precisely the same moment, across three time zones. These particular procedures started at 7:30am in Vancouver, 8:30am in Edmonton and 10:30am in Toronto.

After months of planning by Canadian Blood Services and medical teams in all three cities, kidneys were removed from four living donors and transplanted into four patients suffering from kidney failure.According to The Kidney Foundation of Canada, there are currently over 2,900 Canadians on the kidney transplant waiting list. More than two million Canadians have kidney disease or are at risk. For more information visit the Kidney Foundation at