In paired transplant exchanges, relatives or friends who want to donate to a loved one but are incompatible, can still contribute by giving their kidney to an unrelated recipient they match. In turn, that recipient's incompatible donor gives up their kidney.
In Robyn's case there were three couples involved, in which either the wife or husband needed a kidney and the other wanted to donate, but were not compatible.
The third couple in the swap was a South Korean husband and wife living in Silicon Valley. It was decided Alan, Robyn's husband, would fly to San Francisco where all the surgeries to remove the kidneys would take place at the same time. Robyn would remain behind, for fears of complications and that travel outside of Baltimore could compromise her health.
In April 2007 at the California Pacific Medical Center, Alan's kidney was removed and given to the South Korean wife. Her husband's kidney was transplanted into Patrick Barron, and Tomomi Barron's kidney was removed and placed in a cooler that was tracked with a global positioning system.
Montgomery took the kidney on a journey through the streets of San Francisco, onto a chartered jet, and finally by helicopter to Hopkins to successfully transplant it into his patient Robyn.
It was the first time a kidney swap had been arranged between two hospitals and at such a great distance.
"It did mark a change for the way this is going to be done in the future," Montgomery said.
The success of this bicoastal triple swap was helpful in getting the United Network for Organ Sharing (UNOS), the organization that allocates organs to recipients for the federal government, to push forward its blueprint of a national program that arranges and matches up kidney exchanges like this one, he said. The goal is to have the program in place by 2010.
"It's great and I think it's going to increase the number of transplants by 1,500 a year," Montgomery said. "In the meantime, we're going to continue doing what we're doing."
Thanks to her new kidney, the "color has returned" to Robyn's cheeks and she says she will be forever grateful to the person who gave her "another chance at life." She knows how lucky she is to have Alan and her family for support.
But after fighting for her future, she now must face its reality, which is not without financial hardship. She is struggling to find a job as a computer programmer, which is what she did before she got sick, and Alan, although fully recovered, got little money for the time he had to take off from his truck driving job for the surgery. They worry about losing their house.
"The swaps are fantastic don't get me wrong," says Sally Satel, scholar at the American Enterprise Institute and recipient of a donor kidney herself. "But we should reward individuals because it could encourage even more who might not otherwise rush to donate."
Satel, who is writing a policy book titled "When Altruism Isn't Enough: The Case for Compensating Kidney Donors," said she believes people might need incentives to donate organs.
She, along with various physicians, economists and legal scholars, are pushing for a government-regulated system to provide incentives for people willing to donate to a stranger, such as contributions to a retirement fund, lifetime health insurance, or vouchers for a child's school or college.