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How old is too old for a transplant?

Kidneys are scarce. Elderly patients may get fewer if rules change.

November 05, 2006|Alan Zarembo | Times Staff Writer

DENVER — It was Monday, Shawn Stringfellow's usual night to shoot pool.

He gunned the engine of his Harley-Davidson and pulled out of the restaurant parking lot as his fiancee waved goodbye.

He was 30 years old, healthy and happily employed as a heavy-equipment mechanic. Soon, he and Kellie Highland would be married.

"I love you," she mouthed, as his black leather jacket disappeared into traffic.

With his crisp goatee and helmet-less head, Stringfellow looked like a tough biker. "If I wanted to wear a helmet, I'd ride in a car," he liked to say.

He had a soft side, though. He roared down the street wearing jeans covered with tiny hearts that Highland had scribbled in ballpoint pen during dinner.

He'd promised to be home by midnight.

Life is unpredictable. Just before 11 p.m., he finished his last beer at the pool hall and fired up the Harley. A few miles down the interstate, he drove off the side, struck a construction barrel and rolled his motorcycle.

The next day, May 7, 2002, he was on life support. His heart was still beating, but he was brain-dead.

With his family's consent, calls went out to transplant centers throughout the region. He was an ideal organ donor.

Dr. Ben Vernon, the transplant surgeon on call across town at Porter Adventist Hospital, received the news around midnight: two young kidneys -- blood type A-positive -- available in Denver.

A patient of his stood a strong chance of getting one. This man had waited a long time -- three years. To Vernon, it looked like a go.

He instructed his staff to summon the patient to the hospital. The staff also called Dr. David Gillum, another member of the transplant team.

Gillum sat up in bed and shuddered: The patient was 85 years old.

Were they serious?

What was the sense in giving such a perfect kidney to such an old man when hundreds of younger people were waiting nearby?

Exciting news

The telephone rang around midnight at 85-year-old Clois Guthrie's house on the plains northeast of Denver.

This was it, his chance. He and his wife, Nina, hurried to pack.

Guthrie, a retired osteopathic surgeon known to friends as Gus, had spent much of his life piloting small airplanes into the Colorado hinterlands to remove infected gallbladders and ruptured appendixes. He'd been a bull of a man, with a full life. He had married twice, raised three children and water-skied on Lake Powell well into his 70s.

Now, he was a full-time patient.

At a dialysis clinic 45 miles from his farm near Fort Morgan, Guthrie would slump in a padded recliner for hours, sleeping or watching other patients as the machine filtered toxins from his blood. The air always smelled of bleach, used to clean the machines.

His world had changed so quickly.

Five years earlier, he had gone to the hospital for a heart bypass and valve replacement operation. During the procedure, his kidneys began to fail.

Within a year, they were useless.

He told Nina that he would rather die than go through the misery of dialysis.

He eventually relented. He sat in his chair quietly now, like everyone else, hoping for a kidney transplant.

Unlike livers, hearts and lungs, which are aimed at the patients most likely to die without new organs, kidneys go primarily to those who have waited the longest, though genetics play a role.

It was possible to circumvent the process by getting a kidney from a relative, and Guthrie's son, wife and sister-in-law had each offered to donate one of theirs.

But Guthrie refused. "I'm not selfish enough to consider that," he told his wife.

His kidney would have to come from somebody who had died.

Two transplant centers, in Scottsdale, Ariz., and Seattle, had refused to accept him on their lists because of cancerous cells found in his prostate, even though they did not appear to be multiplying.

Porter Adventist -- the same hospital where he'd had his heart operation -- finally offered him a spot in line.

On this morning, Guthrie was third on the local waiting list, a backup behind two younger patients at other transplant centers in Denver. If either of those candidates was unavailable or unsuitable -- a common occurrence -- he would get his kidney.

Nina took the wheel of their Cadillac and raced to the hospital 100 miles away.

As the Denver lights grew closer, the couple talked about what life might be like again without dialysis -- a time they both could barely remember.

Vehemently opposed

Gillum was determined to prevent the transplant.

The kidneys could last decades if given to younger patients, the nephrologist told Vernon, the surgeon, on the phone that morning. Guthrie probably had just a few years more to live, with or without a transplant. He could die on the operating table.

It was not just unreasonable, Gillum contended, it was unethical to give a young kidney to an 85-year-old.

Vernon, who had performed hundreds of transplants, was confident that Guthrie was healthy enough to survive an operation.

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