Jennifer Fish needed a new kidney, and her sister Allison desperately wanted to help. But when Allison found out she wasn’t a match, the sisters found help through a paired exchange program. In the end, Allison’s kidney helped a man named William and a generous donor named Susan gave her living kidney to Jennifer.

News, Your Health | one year ago

Two Sisters, Two Donors: A Kidney Donation Exchange Changes Two Lives

Jennifer Fish needed a new kidney, and her sister Allison desperately wanted to help. But when Allison found out she wasn’t a match, the sisters found help through a paired exchange program. In the end, Allison’s kidney helped a man named William and a generous donor named Susan gave her living kidney to Jennifer.

Jennifer Fish is a survivor who is no stranger to remaining steadfast with medical treatments. After a series of health challenges related to leukemia and radiation chemotherapy, she needed to be on dialysis to survive. After her kidney failed, she faithfully made it to dialysis three times a week for more than two years.

Jennifer’s younger sister, Allison, saw the toll it was taking on her to continue to go to dialysis. The trips several days a week for treatment were emotionally and physically draining. Without question, her immediate reaction was to try and become her donor.

“I love my sister. I didn't want to see her declining health and I wanted to do everything I could. So, I figured it was one small thing that I could do. I'm young, I'm healthy, and I had two kidneys. It was something I knew I could do at least to help save her.”

But when she found out that she wasn’t a match, their initial plans were sent into a tailspin. Thankfully, Atrium Health put them on the list to participate in a paired exchange program, an alternative option that allows an incompatible donor to be matched with another compatible patient in exchange for a compatible donor to be given to the initial patient. It can become a swap or “chain” of donations.

Paired Donation: Paving the way

Vincent Casingal, MD, FACS, chief of the division of abdominal transplant and the surgical director of the kidney transplant program at Atrium Health worked closely with the sisters. His experience working with over 120 transplant patients in the area every year, along with his impressive national reputation and appointment as chair of the kidney committee at the United Network for Organ Sharing (UNOS) have contributed greatly to Atrium Health’s transplant center.

“There are two ways that somebody gets a kidney. One is from the deceased donor list, which is when somebody dies and donates their organs. The wait time can be somewhere between five and seven years. In fact, the majority don't get a transplant in the first few years. It takes quite a number of years and many people get too sick at that point,” says Dr. Casingal.  

“The second way is to receive a kidney from a living donor. Living donors are so successful because people get the kidneys earlier before they get too sick. The living donor kidneys work better and work longer on average too. It’s easier to optimize the situation and transplant somebody in a healthier fashion — in a more elective time period too. This simply produces better results.”

While quick action matters, the type of donation also plays a role in a transplant’s success.

“With living donor kidneys, we see the most striking differences. When patients come here and see the donor kidney picking up right away, making urine and filtering the blood —  it's exciting every time,” says Dr. Casingal. “Seeing patients light up when the transplant starts is always very rewarding.”

The Wait for a Match

Jennifer was on dialysis for two and a half years while waiting for a donor —  living or deceased. Also, Jennifer’s situation became more urgent because the dialysis was starting to affect her heart.

When time is of the essence, finding the right match can make a world of difference. A paired program requires a lot of coordination and communication, but it can help quicken the process.

In early 2020, Jennifer finally got the good news. Susan Walker, a nurse who works in the field of vascular access, was a match. She decided to become a kidney donor after seeing so many dialysis patients up close.

“I had seen how grueling this life can be.. And so for me, I thought,’ I have two kidneys’, why not give one to someone to do good? I didn't know who was going to get my kidney. Atrium Health really handled the bulk of the organizing that I had to go through and my testing. It took about two and a half months to go through it. They certainly wanted Jennifer and I to both be safe.”

Meanwhile, Allison wanted to help someone else facing a similar situation as her sister. She pursued the living donor process and her kidney was found to be a perfect match to William Ellis. At this point, he also had been on dialysis for almost three years. “I was born with only one partial kidney,” says William. “They didn't find any of that out until I was about 13 or 14 years old when I was admitted for asthmatic bronchitis and high blood pressure. I got my first kidney transplant at 15.”

Ellis had this kidney for almost 17 years, which was his father’s, until it failed. In 2016, he was placed on the kidney donation list. After that, he restarted dialysis for nearly 3 years, going three times a week.

“Dialysis takes a lot out of you, it drains you. You want to go home and take a nap. I couldn't lift 10 or 15 lbs or do strenuous activity.”

The Results

Now that both Jennifer and William have new kidneys, they have regained the freedom they missed. “I’m very grateful for this opportunity. Now I can do things without getting tired, like clean, go jogging and running,” says William. “Without Allison’s kidney, I couldn’t do these things. Also, I’d still be in dialysis three times a week and not able to live my fullest life.”

Six days after surgery, and immediately prior to COVID-19 hitting the United States, the donors and patients wanted to see each other face-to-face. Meeting like this so quickly isn’t common, but it was something the four felt strongly about doing. To say there wasn’t a dry eye in the room is an understatement.

“The donation means literally my life to me. I have the energy to do things I haven’t been able to do before, like driving across the state or attending a party. I wasn’t too tired or too sick or wondering how I would get somewhere. Susan will never know how grateful I am to her,” says Jennifer.

Susan also feels grateful to be a donor. “The gift to me… it’s surreal. I’m just happy that I could do it. And to see Jennifer’s joy is just wonderful.

Success like this doesn’t happen alone. It took an orchestrated effort of physicians and the care team at Atrium Health to get everything together. The navigation team and transplant team that helps living donors get matched also played large roles in this successful outcome. Dr. Casingal is thankful for his team and proud to be part of the only transplant center in Charlotte.


A year and a half later, Jennifer and William are doing well after their transplants. These results are life-changing because individuals with transplants live longer than staying on dialysis. They also feel better and get the freedom to go and do what they like again.

In Charlotte, Atrium Health does over 120 transplants a year. That number changes based on how many donors are available, and how they're shared through the country. The more donors there are, the better the chances are of people like William and Jennifer finding a match during a time-sensitive wait period.

To those considering donation, Dr. Casingal says, “There are a lot of ways to get information without committing yourself. We are here to answer your questions, to provide you with information on the process, to provide you with information on whether it may be right for you.”

Jennifer also encourages anyone who is able to donate what they can, “If you can donate marrow, blood, or your kidney, or even check that box on the back of your license, do it — you have no idea whose life you can save.”

Learn more:

Read Celeste’s transplant story

Learn more about our kidney transplant team

Learn more about kidney transplants and the COVID-19 vaccine