SCOTTSDALE, AZ (ASRN.ORG)- It began like many other days in Transplant at Mayo Clinic: Multiple transplants. Courageous people willing to donate their kidneys to loved ones in dire need. And grateful patients on the crest of a new chance at life. 

In what was a first for Mayo Clinic, a Benson, Ariz., man became the recipient of a life-saving kidney transplant, thanks to a caring donor — and an innovative plan to help three patients at once.

The caring donor to Lawrence Walsh, 66, Benson, Ariz., was not a relative — or even a friend. The donor was a virtual stranger, part of a "swap," or what is called a paired kidney exchange, that began with a donor at Cornell University in New York. That donor kidney was shipped to a patient in need at California Pacific Medical Center in San Francisco.

In turn, California Pacific reciprocated by sending a matching kidney from one of their living donors to Mayo Clinic — specifically intended for Lawrence Walsh.

Mayo Clinic contributed to the creative chain of good deeds as well. Walsh's son, Brian, 41, Tucson, Ariz., had hoped to be his dad's kidney donor, but was not a match. But he got his chance to contribute the gift of life when his kidney was removed at Mayo Clinic and was then shipped to a patient in need at UCLA Medical Center in Los Angeles. 

The chain that began in New York involved six surgeries (three surgeries to remove the donor kidneys and three kidney transplants), four hospitals, two time zones and weeks of careful orchestration and planning. As a result, three patients in need of a kidney who otherwise would have to join the 80,000 other Americans on a waiting list for an organ were able to become recipients of healthy, matching kidneys.

Such "swaps" are possible when an incompatible donor/recipient pair is found to be a good match with another incompatible pair — often outside of a singular medical center. The recipients then "swap" donors.

Walsh, who suffered from high blood pressure that affected his kidney function for a number of years and who knew he would eventually be on the path for a transplant, is grateful to his anonymous kidney donor — and extremely proud of his son, Brian. "I am so proud of him. He couldn't donate to me because we weren't a match. But he mustered up the courage to donate to someone else," said Walsh. 

Brian's mother, Arlene, who now is caregiver to her husband while he recuperates from surgery, echoes that pride, and was comforted knowing she could see Brian in the pre-op area before he was taken to the operating room to donate to a stranger. 

It was a long day for the Walsh family while waiting at Mayo Clinic Hospital. Brian Walsh arrived for his surgery to remove one of his kidneys at 5:30 a.m. Lawrence Walsh underwent his kidney transplant after his donor kidney arrived at 4 p.m. Arlene spent 17 hours looking after the two patients. 

Brian wasn't alone in his selfless spirit to donate a kidney to his dad. His two brothers had stepped up to be tested, but for various medical reasons were not qualified to donate. Lawrence Walsh's brother was a match — but a decision was made not to put him at risk of surgery.

Brian Walsh knew early on he was not a blood match for his father, and agreed to participate in the kidney exchange, affirming, "There wasn't a choice. It was something I wanted to do." Organ donation wasn't something on Brian's radar screen. "I hadn't even checked the box on my driver's license," he said. Now, however, he is pleased with his father's progress and wants to contact the woman at UCLA who now has his kidney. "I want to make sure she is doing well," he notes. He also credits his continued successful healing to help from his friend and caregiver, Linda Bordeleau, Quebec. 

"This paired kidney exchange is an important development in the practice of kidney transplantation," said Raymond Heilman, M.D., Chair of the Division of Nephrology at Mayo Clinic. "This exchange means that three patients were able to get a compatible kidney when none would have been possible otherwise. Because of the limited supply of available organs, this is a way to increase the number of patients receiving organs." 

The pairing of kidneys among multiple medical centers was a first for Mayo Clinic and is fairly new in the Southwest. Such collaborations with other centers that register their willingness with the National Kidney Registry are being recognized as having a significant impact on the potential to expand the donor pool, according to Dr. Heilman. 

Dr. Heilman also reported that all of the patients in the exchange were doing well.

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