kidney donor with Give Life tattoed on knuckles

Search #muscrounds on the free case-sharing app Figure 1 ( to view the annotated photographs and associated comments from the MUSC Health virtual grand rounds on kidney transplant.

Kristy Hokett (pictured at left) has the words “Give Life” tattooed on her knuckles. She was moved to get the tattoo when she saw the good that came from her aunt’s decision to donate her organs upon her death. A few years later, when her father tried to donate a kidney to his former colleague Thomas House, but was not a good candidate, Kristy offered to step in. In the past, all of these acts of generosity would have come to nothing when it was determined that Kristy was not a good match for Thomas. Today, with the availability of the kidney chain program, Kristy was able to give her kidney to another well-matched recipient, ensuring Thomas in turn received the kidney he needed. 

Three MUSC Health transplant surgeons (see photo below) were involved in this series of transplants—Satish N. Nadig, M.D., Ph.D.Charles F. Bratton, M.D.; and Prabhakar Baliga, M.D., Chair of the Department of Surgery at MUSC Health. Using surgical photos from this series of transplants, Nadig led a virtual grand rounds on the free case-sharing app Figure 1 (Android and iOS) on January 27, 2016. To view the annotated photographs and comments from the virtual grand rounds, search #muscrounds on Figure 1 ( To see all posts of surgical photographs from MUSC Health, search @MUSChealth.

The Need for Living Donation

There are currently more than 100,000 people waiting for life-saving kidney transplants in the United States. Four out of five patients in need of a kidney go without one, many of whom must in the meantime rely on dialysis. Extended times on dialysis are associated with worse outcomes after transplant and place a huge economic burden on the health care system.

Living donors are crucial to reducing these statistics. An organ from a living donor lasts twice as long and provides the highest quality at the lowest cost. Living donor organs both reduce wait times and begin to function faster after transplant.

The MUSC Health Kidney Transplant Program, which began in 1968, numbers among the nation’s leading academic transplantation programs. MUSC Health is also South Carolina’s only Living Donor Transplant Center, kidney transplant surgerywhere more than 800 organs have been donated by living donors. 

Kidney chains remove the constraint of compatibility from living donation, expanding the pool of patients who can benefit. In effect, they unleash the power of generosity inherent in the decision to donate.

MUSC Health initiated its first kidney chain in 2013 (read story here) and participated in the longest chain the NKR has ever done—35 transplants—in 2015. The January 2016 chain involving kidney donor Kristy Hokett was MUSC Health’s twelfth, and the seventh that it originated. Hokett’s surgery was featured on the Figure 1 app to help build awareness among physicians and medical students about the importance of this revolutionary approach to kidney transplant.

How the Chain Works

Using a sophisticated algorithm, the National Kidney Registry (NKR) helps identify donors and recipients who would likely be good matches, though they may live in distant parts of the United States. More than 70 institutions, including MUSC, participate in the registry.  

The chain of kidney transplants is set off with an altruistic donation. A good Samaritan donor offers up a kidney without designating a recipient. The incompatible donor of the first recipient in turn “pays it forward” by donating his or her kidney to a recipient that is a good match for that kidney (View Figure), and the process continues on until a kidney comes back to the institution where the good Samaritan donation occurred or is given to a patient enrolled in the Children and High Panel-Reactive Antibody (PRA) Program (CHIP).

Paying It Forward

Good Samaritan donor Candace Potter initiated the January 2016 chain involving Kristy Hokett. She was a match for Thomas, enabling Kristy to donate her kidney to a well-matched recipient in the Charleston area.

“Your donor can give to the NKR list and it expands your options,” says Sara Parker, R.N., MUSC’s NKR coordinator. “A patient with a living donor is not bound to that one donor—that donor is a ticket into an exchange where there is greater genetic diversity and a greater chance of a good match.” In short, having a living donor, albeit an incompatible one, gains one right of entry into the NKR, where the right kidney might await.

By helping solve the problem of incompatibility, the kidney chain makes more living donations possible. For the donor, the kidney chain offers an opportunity to magnify the impact of their good deed. Instead of helping one, the donor is instrumental in helping many.

 For more information on the availability of kidney chains at MUSC, contact Sarah Parker, R.N., NKR coordinator, at

For more information on innovation at MUSC Health, see Progressnotes, MUSC's medical magazine (

The Living Donor Institute

The MUSC Living Donor Institute is striving to create a nationally recognized program to serve as a leading resource for transplant patients and live donors through the pursuit of innovation. Its goals are to improve living donation education and access, improve transplant quality, and support research into high-tech alternatives to transplant.