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Against the odds: A lengthy ‘daisy chain’ transplant benefits elderly

Henry Tai (fourth from left) surrounded by his family, including daughter Cynthia to his right. (Photo courtesy of Tai family)

Special to Hawaii 24/7

At age 80, receiving a kidney transplant was nearly out of the question for Honolulu resident Henry Tai.

Most program requirements place limits on age (e.g. the person must be a certain age to enter the waiting list). Though much research has been done and many studies suggest that age alone should not be a factor, dialysis patients over the age of 65 experience many obstacles when trying to receive a transplant.

Hoping to enhance the quality of her father’s life, Cynthia Tai left The Hague and began the process of being a living donor in San Francisco. Unfortunately, though matched genetically, their tissue type did not match up, and Cynthia was deemed not a suitable donor for her father.

Although the traditional route of organ transplant did not seem accessible for Henry, rather than being discouraged, the family sought an alternative solution. They opted to proceed with testing in the hopes that a matched donor could be found.

In March 2009, the New England Journal of Medicine, reported an extraordinary set of kidney transplants made possible by donors who gave their kidneys to people they did not know.

Dubbed, the “NEAD (nonsimultaneous, extended, altruistic donor) chain” or “daisy chain” transplant, organizations help link potential donors with recipients around the world.

It all begins with a kidney from an altruistic donor that is a possible transplantable match to a patient who has a relative or friend willing to donate but whose kidney is not compatible by blood or tissue type.

Once the altruistic donor kidney is matched up and transplanted, the kidney from the willing donor from the original incompatible pair goes on to assist another incompatible donor-recipient pair and so on.

Through this route, Cynthia was able to donate her kidney to a donor-recipient pair, who then donated to another pair, and then eventually it led back to her father receiving a kidney from another donor-recipient pair.

Procedures such as these are carefully orchestrated with donors and recipients in various locations and coordinated to preserve the integrity of the kidneys. This particular chain facilitated 12 transplants at seven medical centers across the country.

On Feb. 18, 2010, Henry received his kidney at the University of California, San Francisco Medical Center, the day it was removed from a woman at the University Medical Center of Southern Nevada. In a nearby operating room, at virtually the same time, a single mom with two children in California was the benefactor of Cynthia’s kidney.

Though the recovery rate is one to two months post-operation, Cynthia was back online and continuing her work as a trial lawyer with the International Criminal Court in The Hague just days after the operation. Her father, though an elder recipient, spent no longer than younger recipients in healing and getting back to his everyday tasks.

At approximately the same time this operation was taking place, Dorry L. Segev, M.D., Ph.D., an associate professor of surgery at John Hopkins University School of Medicine, released a statement supported by the American Journal of Transplantation, stating that patients over the age of 65 were waiting longer than necessary for a lifesaving kidney because their doctors failed to put them in a queue for organs from senior donors.

It was believed that older kidneys once were discarded because they conferred too little benefit. However, studies have found that it is actually untrue. By accepting these kidneys, an older person’s chance for survival actually increases. Kidneys from older donors are not expected to live as long as those from younger ones, but older recipients do not need organs to last as long. Studies have found that those willing to accept older kidneys are in fact more likely to be transplanted sooner than those waiting to accept a younger kidney. The mortality rate of those on dialysis waiting for a transplant is higher than that of those that have opted for an older organ and received their transplant sooner.
Now, after two years, and against the odds, Henry Tai is as healthy as ever. Both he and Cynthia have “no regrets.” Cynthia has even stated, “This was one of the best decisions I have ever made.”


Henry Tai, born on Kauai, was a former Administrative Law Judge in Honolulu. He is currently retired and still resides on Oahu.

Cynthia Tai is currently an attorney for the International Criminal Court (ICC) in The Hague. Prior to her position with the ICC, she was a deputy prosecuting attorney for the County of Hawaii.

She returns to the states often to give lectures and speeches on the progress of the ICC in prosecuting individuals that are responsible for the most serious crimes of concern to the international community.

These are crimes that threaten the international community as a whole. These crimes, falling within the jurisdiction of the ICC are genocide, war crimes, crimes against humanity and crimes of aggression.

— Find out more:
National Kidney Registry:

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