When Giovanni was born, he was two months premature, had cysts on his brain and his lungs were not fully developed. Three days later his parents learned his kidneys were failing.
"Although kidney failure didn't sound great, we didn't think that was the worst thing he could have relative to his other problems," Giovanni's mother, Michelle, says.
But by the time he was just 14 months old, Giovanni needed a kidney transplant. No one could have predicted then that after years of unlikely events and near tragedies, he would receive a second kidney from an unknown living donor in San Antonio, thanks to the Texas Transplant Institute's Incompatible Live Kidney Donor Exchange Program-;the largest living donor kidney transplant program in the United States.
When Giovanni was still a baby, he was one of the youngest and tiniest children-;barely 20 pounds-;to receive a kidney from a living donor. His mom was a match, but her mother, Giovanni's grandmother, wanted more grandchildren and, after the difficulties with Giovanni's birth and knowing Michelle was at high risk of another difficult pregnancy, she insisted on being his donor.
The transplant was a success but Giovanni soon developed a number of complications. He was diagnosed with Epstein-Barr virus and BK virus-;both of which put Giovanni's new kidney in danger of rejection.
Worse still, Giovanni developed post-transplant lymphoproliferative disorder (PTLD), a type of lymphoma associated with the Epstein-Barr virus that can occur in a small number transplant patients. Giovanni was about to start chemotherapy when his doctors discovered the PTLD was controlled by stopping Giovanni's immune-suppressing medications and by giving him intravenous injections of immunoglobulin to compensate for his weakened immune system.
In general, a transplanted kidney from a living donor can last 15 to 20 years-;at least that's what Giovanni and his family expected. But, likely as a result of his complications, after just two years, they learned that his graft was failing and he would need another kidney within six months. Luckily, with dialysis, it lasted another two years.
In the meantime, all of the tests were completed and Michelle prepared to give her kidney to Giovanni. But just two weeks before the scheduled surgery, there would be another, very serious complication.
Giovanni had a bad accident while riding his bicycle. His pelvis collided with the front of his bike rupturing his graft and putting Giovanni in danger of bleeding to death. His father, Peterson, and a neighbor performed CPR until paramedics arrived. Then Giovanni was taken by helicopter to Egleston Children's Hospital in Atlanta, Georgia, almost a 90-minute drive from their home in Buford. At the hospital, the bleeding was stopped but the blood and blood products that were transfused to save his life altered Giovanni's antibodies and his mother's kidney was no longer a match.
"That was the roughest part. When my mom donated, we knew we had a back-up plan for when Giovanni would need another transplant, but now, after the accident, I couldn't give him my kidney and he couldn't escape dialysis. It was a really tough time," Michelle says.
Giovanni's family learned he had only a one percent chance of finding a suitable donor and faced the prospect of waiting for a deceased donor kidney for up to five years. Uncles, cousins, congregants from their church and neighbors-;some they barely even knew-;offered to be tested. In the end, Giovanni's dad, a native of Brazil, was a match.
And, as if they hadn't already been through enough, during the surgery to remove the donor kidney, the surgeons discovered Peterson's kidney couldn't be used for Giovanni's transplant. It was more devastating news.
So now, with few options remaining, Giovanni's family considered traveling to Brazil where they hoped he would have a better chance of finding a match with a Latino donor. But Dr. Chris Larsen, Executive Director, The Emory Transplant Center in Atlanta, Georgia, had another recommendation-;the Paired Donation Kidney Transplant Program at Texas Transplant Institute at Methodist Specialty and Transplant Hospital in San Antonio, Texas. Dr. Adam Bingaman, kidney transplant surgeon and director of the program, had completed his surgical residency and a PhD in Immunology at Emory University and Dr. Larsen called him to discuss Giovanni's situation. Not long after that phone call, they found a match.
In the Paired Kidney Donor Exchange program, Michelle and Giovanni are paired with another couple who are incompatible and the matching kidneys are exchanged.
"It is just the most remarkable thing-;they had someone already in Dr. Bingaman's database-;waiting for a match. Without Dr. Larsen and Dr. Bingaman sharing the information, we were headed back to Brazil," Michelle says. "I hope this program expands and goes nationwide. There are so many families willing to donate. Because of this database, I was still able to donate my kidney and Giovanni got one, too. It all worked out beautifully."
Michelle's kidney went to a recipient in Texas who also had only a one percent chance of finding a match due to high levels of antibodies from pregnancy. She is doing well since the transplant.
And what made it even better was that Michelle and Giovanni never had to travel to Texas for their surgeries: Michelle's kidney was removed and shipped to San Antonio, and the kidney for Giovanni was shipped to Atlanta so everyone could be close to home throughout the transplantation process.
"That part, I can say, was awesome! Michelle exclaims. The only thing Michelle and Giovanni regret is that they were not able to meet Dr. Bingaman to thank him for making it all possible!
Despite all the events surrounding Giovanni's second kidney transplant, Michelle is grateful for how things turned out. "We concentrate on how we helped our family and another family. Everything happens for a reason-;if things hadn't happened the way they did, we wouldn't have helped another family," Michelle says.
Today, Giovanni, now 10 years old, is doing well…so well, in fact, that his parents often have to tell him to take it easy. "He beats me to the elevator when we go to the hospital for check-ups. I used to have to take him in a stroller and now he beats me!" Michelle says. Enjoying the freedom from being off dialysis, Giovanni is still not keen about riding his bike. But he does love to do flips into their swimming pool-;much to the consternation of his parents. "We get scared-;he's very daring. Just yesterday he flipped into the pool and my husband and I panicked and looked at each other and said, ‘What do we do?' And we just let him be a kid and said, ‘Good jump, Giovanni!'"
The local NBC affiliate in Atlanta, Georgia, followed Giovanni's story for several years. To read more about him and watch his homecoming video: click here.
Texas Transplant Physician Group kidney transplant surgeons serve patients at Texas Transplant Institute's Kidney Transplant Program on the campus of Methodist Specialty and Transplant Hospital in San Antonio, Texas.