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Published date: June 19, 2025
Imagine planning and hosting an elaborate event, like a large wedding, that involves coordinating dozens of people - the florist, musicians, photographers and caterers - while making guest lists, travel arrangements and securing a venue. Imagine hosting three of those elaborate events over four days. Now imagine three lives depending on every part of those events going smoothly - that's a glimpse into the work of the Arkansas Children's Hospital (ACH) kidney transplant team.
It's 9 a.m. on a Thursday when Brian Darnell, DNP, MSN-NE, RN, CCTC, one of two kidney transplant coordinators at ACH, gets the call from the United Network for Organ Sharing (UNOS) - a kidney from a deceased donor may be a match with one of our patients. Coordinating the first elaborate event begins.
"There are so many people that make a transplant work and go smoothly," Darnell says. "I'll send over 100 texts and phone calls for one transplant."
One of the first calls is to the patient's parents or caregivers. In this case, the potential recipient is on hemodialysis. Their kidneys have failed and cannot filter waste, salts and fluids from the blood, so a dialysis machine does the filtering. A kidney transplant could free the young person from being tethered to a machine for several hours a day, multiple days a week.
UNOS uses an algorithm to determine which patients in the national registry are possible candidates when a kidney is donated. Factors include whether the recipient is on dialysis, blood type compatibility and the geographic distance between donor and recipient. A blood test, called a crossmatch, tests cells from the donor's kidney with antibodies in the recipient's blood to ensure the recipient's body will accept the donated kidney.
When Darnell receives the first call from UNOS, there is no guarantee that the ACH patient will receive the kidney or that the donated kidney will be suitable for the recipient, but the team is always prepared. An organ donation can come at any time, day or night.
Instead of florists, musicians and caterers, this elaborate event involves the patient, their family or caregivers and:
Every transplant story includes an unavoidable moment of anxiety and anticipation for everyone involved: the arrival of the donated kidney.
Even with good results from crossmatching, transplant surgeons must visually inspect the kidney before surgery. Darnell says, in rare cases, "We've received the kidney in the operating room and, after the surgeon opens up the box, realizes there's something wrong, and we've got to cancel." A donated kidney may arrive damaged or be too large for the patient. Regardless of the reason, he says, "It's heartbreaking to tell the family."
The news is good for this patient. The kidney is healthy and able to be transplanted. The family moved to Arkansas to receive kidney care at ACH. English was not their primary language, so trained medical interpreters were available throughout the process to explain complex medical procedures clearly. Friday evening, the patient is in recovery after a successful surgery.
Most team members in Friday's transplant rest on Saturday after the procedure. Up to this point, it's been a quiet year for kidney transplants. ACH averages seven kidney transplants a year, and they've just completed their fourth. Quiet years aren't unusual because pediatric kidney transplants are rare. According to data from the U.S. Department of Health and Human Services, the U.S. averages only 800 pediatric kidney transplants annually.
16-year-old Daveion Andrews loved playing football for the Conway Wampus Cats. He envisioned being a standout wide receiver. "I was really into it and working hard to be at a starting spot," he said.
His pediatrician referred him to Arkansas Children's for abnormally high blood pressure. Testing revealed focal segmental glomerulosclerosis (FSGS), a rare disease that impacts around one child in every 100,000 annually. The disease causes scar tissue on the small parts of the kidneys, preventing them from effectively filtering waste from the blood.
Daveion remembers the moment he realized the impact of his diagnosis. "We went to my grandparents' house to have dinner. My dad called me into a room and told me that I wasn't going to play football anymore. It broke my heart because I was getting better, progressing."
His mother, Markisa Lasker, says the news was hard for her too. "I was very heartbroken to find out my son had kidney failure. I was emotional. I questioned, Why him? But, being a believer, praying about it and reading the Word brought both of us closer to God."
For nearly a year, the family prayed and made regular trips to ACH to manage Daveion's condition. His care team added him to UNOS's national registry of approximately 90,000 children and adults in need of a kidney transplant.
Daveion's FSGS caused his kidneys to deteriorate rapidly. Weeks before his 17th birthday, his care team began educating the family on dialysis and the decision they needed to make about whether to drive to ACH in Little Rock multiple times each week or be trained to operate the machinery necessary to support his kidneys while at home.
"We had decided to come to ACH three days a week," his mother recalls. "We were capable of doing it ourselves at home, but we feel comfortable with the team here." Both she and Daveion describe the care team as "family."
“I love them,” Daveion says.
The ACH team prefers pre-emptive transplants — before a patient goes on dialysis — because evidence shows several benefits, including an improved likelihood that the recipient’s body will accept the new kidney.
The week before his birthday, Daveion's family gets a call - a potential kidney is available, and Daveion is close enough to the top of the waiting list that he needs to head to ACH. Daveion moves to the top of the waitlist when he arrives, and UNOS offers ACH the kidney. He's prepped for surgery when the news comes: the kidney isn't a good match. After reviewing the donor's health factors, the transplant surgeon and physician decide there are too many risk factors, so they decline the kidney.
Without a suitable kidney, Daveion will need machines to filter the blood since his kidneys cannot. His care team and family decided to start dialysis two weeks after he turns 17.
The week dialysis is scheduled to begin, the call from UNOS comes again - another potential kidney is available. Once again, Daveion travels to ACH, and the donated kidney arrives. The news is better this time; the kidney is healthy and a match. Surgery is successful, and recovery begins.
Daveion says, “The best memory is when they told me that the kidney was good and I was going to be prepped for surgery.”
He’s glad to be able to work out again and has rejoined the Wampus Cats as a team manager.
While preparations were made for Daveion's surgery, UNOS called ACH again - another kidney is available. The second kidney from Daveion's donor is a possible match with a different ACH patient. Like Daveion, the patient will be able to avoid dialysis if the pre-emptive transplant is successful.
At 6 p.m. Monday, Darnell calls the family who lives three hours away in northwest Arkansas. Then, he begins coordinating the care team.
Dr. Millner, the pediatric nephrologist on duty for all three transplants, says, "We almost never transplant both kidneys [from the same donor]. It's really rare."
In this case, it's a welcome rarity. By 2 a.m. Tuesday morning, the patient was prepped and in the operating room. The kidney was healthy and a good match. For the third time in four days, the process and procedure went smoothly. The care team was tired but energized by what Dr. Millner described as "an intense joy that you're doing something for somebody that's going to drastically change their lives in a good way."
"Transplants and giving birth are the only times that you go into the hospital excited," she says. "Transplant is one of those things you anticipate and plan for, and you have no idea how it will go. Both require an enormous amount of communication and coordination."
Reflecting on three transplants in four days, Dr. Millner said, "Everyone was very calm and focused." She credits the team for remaining detail-oriented throughout the weekend and into the early hours of Tuesday morning. "We were all communicating so well. I think that was the key."
Teamwork is one of four core values at Arkansas Children's. Under pressure, the ACH kidney transplant team demonstrated the positive impact a culture of teamwork can have on patients, their families and each other.
The pediatric nephrology team at Arkansas Children’s is committed to providing family-centered care and working closely with our patients and families to meet their unique needs.
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