Earlier this month, the Hospital of the University of Pennsylvania and the National Kidney Registry, in partnership with 18 transplant centers across the country, successfully completed the second largest kidney exchange in history and the largest to be concluded in under 40 days. Dubbed Chain 221, the swap involved 56 participants (28 donors and 28 recipients). Four patients at Penn Medicine, including two long-lost grade-school friends, participated in the chain -- two receiving new, healthy kidneys, and two donating their own kidneys to other recipients in the chain. Of the participating centers, Penn Medicine was the only one in the tri-state region.

The life-saving chain began with a kidney generously donated by University of Memphis Law Professor and local county commissioner, Steve Mulroy. From there, the chain involving a family member or friend of each recipient who volunteered to donate his or her kidney, found its way to 28 patients awaiting life-saving kidney transplants across the country. In the 22nd swap of the chain, Penn Medicine patient Gerard Rozycki, Jr., 51, received the kidney he had been waiting for since he was first placed on the transplant list in December 2011. Diagnosed with a hereditary condition when he was 5-years-old, Rozycki had lived most of his life without any physical restrictions. That all changed a few years ago when test results showed rising levels of the waste product Creatinine in his blood and urine, a clear indicator of kidney failure.

In October 2012, nearly a year after being placed on the wait list, a friend Rozycki knew from grade school heard about his condition through a mutual friend on Facebook and decided to help. Distant friends on Facebook only, the two had not been in touch since graduating from high school over 30 years ago. John Furdyna, 52, initially thought he would give Rozycki his own kidney, but the two were not a successful match. Still, Furdyna's willingness to donate on Rozycki's behalf made the pair eligible for Chain 221. Rozycki ultimately received his kidney from another Penn Medicine patient in Chain 221, while Furdyna's kidney was donated to a patient in Madison, WI.

"At first I thought I would help by passing out donor applications, but then I thought 'why don't I just donate?'" said Furdyna. "I knew early on that I wouldn't be a match for Jerry, but I also knew that if I was willing to donate to someone else in the chain, that he would be guaranteed a kidney, too. It was something I could do that would allow two people live longer, healthier lives and ultimately wouldn't have any long-term health effects for me, so I was glad that I could help."

Today, all 56 participants are recovering and doing well. The exchange took a mere five weeks to complete -- a vast improvement over the last year's record-setting swap, which took six months to finish. Experts say the speed with which the chain was completed demonstrates the vast improvements that have been made to the process for identifying organ matches for patients and shows promise for tackling organ shortages in the future.

"Large swaps like chain 221 increase the ability for our patients, some of whom have been waiting on the transplant list for a long time, to find matches," said Peter Abt, MD, associate professor of Surgery in the department of Transplant Surgery at Penn Medicine. "Kidneys are one of the more resilient organs, which makes it possible for us to collaborate on these initiatives with transplant centers across the nation. Through living donors and kidney swaps, we've found an effective means of reducing the organ shortage in this country, and ultimately saving the lives of many who are in need of a kidney."

According to the U.S. Department of Health and Human Services, the 5-year survival rate for patients who receive a kidney transplant is 85.5 percent, compared to 35.8 percent for dialysis patients. Surgeons at the Penn Transplant Institute perform nearly 200 kidney transplants every year, making Penn's kidney transplant program the largest and most experienced program in the region.