Sisters celebrate their 30th kidney transplant anniversary

Thirty years ago, Tammy Meinert was dying. After months of feeling ill — with constant fatigue, headaches, weight loss and difficulty concentrating — the 21-year-old student at the University of Texas at San Antonio was diagnosed with end-stage renal disease.

Her kidneys were failing, and, unless she wanted to spend the rest of her life on dialysis, she needed a transplant.

Fortunately, her sister, Tracy, one year older and in perfect health, was a match. So 30 years ago today, on July 16, 1986, Tammy became the 113th living-donor kidney recipient at San Antonio’s Humana Hospital, which became Methodist Specialty and Transplant Hospital.

Over the past three decades, kidney transplants such as the one the now-married Tammy Rusznak received have become, if not routine, certainly commonplace. In 2014, there were 17,107 kidney transplants done in the United States, according to the Organ Procurement and Transplantation Network, part of the U.S. Health and Human Services Department.

But in 1986, it was still a dangerous procedure with no guarantee of success.

The sisters say that, at the time, they were blithely unaware of the risks. Rusznak was simply relieved to have an explanation for why she was so ill.

“There was one night I felt so bad I didn’t want to go to sleep because I was worried I wasn’t going to live through the night,” she recalled. “But the scariest part was not knowing what was wrong. So I was glad to get the diagnosis because that meant there was something the doctors could do to fix the problem.”

Tracy, who still goes by the last name Meinert, recalls there being surprisingly little discussion before she agreed to donate a kidney to her sister.

“A transplant was the best option, and since she had only one sister, I was it,” she said, adding that she wanted to do it.

Today, Meinert’s only reminders of the procedure are a scar of about 5 or 6 inches on her side and a 3-inch piece of rib the surgeons removed that Rusznak later made into a necklace that Meinert wears on each anniversary of the surgery.

For someone to survive 30 years with a transplanted kidney is “unusual,” said Dr. Francis H. Wright Jr., director of the Methodist hospital’s abdominal organ transplant program. That’s mostly because many transplant recipients are well into their golden years and not expected to live that long anyway, kidney or no kidney.

But improvements in transplant technology mean more younger patients such as Rusznak reasonably can expect to lead a near-normal life for decades to come.

“We’ve got better drug therapies, the ability to better match donors and surgical techniques to make the procedure less painful for the donor,” Wright said. “So we’re able to attract more living donors and improve quality of life for recipients.”

Although skin and eye transplants preceded it, the first successful transplant of a complex human organ was done in 1954 in Boston when Ronald Herrick’s kidney was implanted into his identical twin, Richard.

Early on, societal support for organ transplants was less than unanimous. While most people accepted donations between blood relatives, discomfort lingered regarding transplants of organs harvested from cadavers.

Recalling his days developing the renal transplant program at the University of New Mexico, Dr. Lynn Banowsky, who treated the Meinert sisters, said that “people thought we were killing patients to get to their organs. We’d sort of be ushered into the hospital through the back door whenever we went to harvest an organ. The scrub nurses refused to participate.”

Kidneys were a logical first organ for widespread transplantation, said Banowsky, who also established the renal transplant program at what was then Humana Hospital in 1983.

“The kidneys are a paired organ — you have two. So we can do living donor transplants,” he explained. “And we also had dialysis as a backup, so you could schedule the transplant, and it was there as a backup if something went wrong.”

Although about twice as many kidney donations come from cadavers, living donors are preferred, especially from close family members, because it’s often possible to get a closer match.

During the early days of transplantation, organ rejection was a common problem. Early attempts to prevent it were so ineffective that “we ended up killing a lot of people,” Banowsky said.

One technique used was total body irradiation.

“It was like taking a cannon to blast the whole immune system,” he said.

Immunosuppressant drugs were first developed in the 1960s, and by the 1980s, cyclosporine ushered in a dramatic improvement in transplant patient health. Today, fewer than 10 percent of organ recipients experience any degree of rejection, according to Wright.

Advances in HLA typing, often called “tissue typing,” also improved outcomes. HLA typing involves matching proteins in patients that can play a role in determining whether the organ will be rejected.

Thanks to these and other advances, today the majority of kidney transplants are successful. According to the Organ Procurement and Transplantation Network, only 3 percent of living donor kidneys fail within the first year after transplant, and 14 percent fail within five years. In transplants from cadavers, one- and five-year failure rates are 4 percent and 21 percent, respectively.

As medical techniques have improved, more patients have become eligible for donation, including older and sicker patients who previously would have been rejected. But this expansion also has its drawbacks, most notably in an ever-growing waiting list for organs.

“In Texas, there are more than 50,000 people on dialysis, but we do only about 1,500 kidney transplants annually,” Wright said. “There’s a five- to six-year waiting list, and too many people still die while on that list.”

Several years ago, the sisters reconnected with Banowsky online, and they, along with their mother, Ruth, recently visited him at his home in rural Montana. Now retired, Banowsky said he recalls the sisters’ case clearly.

“It was a perfect situation,” he said. “The girls were a very good match, they understood the situation, and Tammy was exceptionally motivated to take care of herself and to take the anti-rejection drugs she’d need for the rest of her life.”

The surgery was a success, and for more than 20 years, Rusznak was healthy and happy with her new kidney. She married, moved to California and worked at Marymount California University in Rancho Palos Verdes. In 2009, she was diagnosed with IgA nephropathy, which causes scarring of the kidneys, hampering the organs’ ability to filter wastes from the blood.

“They never knew exactly what caused my kidneys to fail in the first place,” she said. “It could have been a virus like strep. Or it could have been an earlier round of IgA nephropathy.”

Rusznak said she’s doing well today and that other than the immunosuppressants she’ll likely have to take for the rest of her life, she isn’t on any other treatment.

“I control my blood pressure and my sodium intake and take care of my health,” she said. “That’s all I can do.”

Meanwhile, the sisters are very involved in efforts to promote organ donation. From her California home, Rusznak is a OneLegacy Donate Life ambassador, speaking to community groups to promote organ donation.

And just a few weeks ago, the sisters won a silver medal for bowling at the Donate Life Transplant Games in Cleveland.

“What my sister did was the most selfless act that someone can do for another human being,” Rusznak said. “There’s not a day that goes by that I don’t think about her and say a silent ‘thank you’ for giving me my life back.”