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9.5.08 Issue #339 Forward This Newsletter To A Colleague

Risa Pollack-Simon
CMC
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The Organ Shortage Crisis - Part 2

In Part 1 of this article, we discussed the organ shortage and living donation. Through extraordinary acts of human kindness, living kidney donation now accounts for almost half of all kidney donors in the United States. In some states like Arizona, there have actually been more kidneys donated from living donors than from deceased donors. Yet, there are still over 76,000 people currently waiting for a kidney1.

Why Donate Now, While Still Living?

The main advantage for a person to become a living kidney donor comes from knowing they are helping someone who needs a transplant now. The main advantage for the recipient is that they can receive a healthier kidney now, before becoming ill. This process can also help the recipient avoid dialysis all together, or at least shorten the term on dialysis, so the patient can be stronger and healthier going into surgery.

The greatest advantage in living organ donation is that a living organ is considered to be a healthier organ when taken from a living donor, because it has continuous circulation prior to removal. This can differ greatly from deceased organs, where the body may have experienced trauma caused by the death. Moreover, there are long-term benefits; the average living kidney is likely to function for an average of 15.5 years, whereas a deceased kidney may only last half as long2.

How Can I Become a Living Kidney Donor?

Generally, people can become living kidney donors if they are between the ages of 18 and 65 years old and do not have any major medical or psychiatric illnesses. They donor cannot be pregnant at the time of surgery, and preferably should not be overweight (although they may still be potential donors after losing weight). If the donor currently smokes, he/she is asked to quit six weeks prior to surgery3. Donors must also be able to understand the risks of this surgery, and be able to comply with medical care and follow-up.

If a person is considering living kidney donation, it is best to contact a social worker at a transplant hospital to see about becoming a candidate. The first step typically involves a brief health screening and interview over the phone in which the potential donor is encouraged to ask questions. If the potential donor gets the initial go-ahead after the telephone screening, the next step is to complete a medical questionnaire and provide confirmation of blood type.

Upon review and approval of this preliminary information, the potential donor will then be asked to complete a medical evaluation by a physician who serves as a “donor advocate” with only the donor’s best interests in mind. Additional tests, such as blood and urine tests, a chest X-ray and an EKG, will also be performed, along with additional tests to ensure the potential donor is healthy and has two healthy kidneys3 to enable a normal life afterwards with just one.

Financially speaking, the donor should not incur any medical expenses related to the evaluation, surgery, hospitalization or immediate postoperative care. These charges are billed to the recipient’s insurance company3.

How Is a Kidney Removed?

Living donor kidneys are removed laparoscopicly4,5, through a minimally invasive approach. Typically, this approach is one that involves a few small incisions that allows video equipment and instruments to visualize, dissect, clip and staple appropriate areas.

Once the kidney is freed from its attachments, it is then put on ice and flushed with a cold preservative solution for “harvesting.” Most amazingly, the kidney can be preserved in this solution for 24-48 hours, but the sooner the transplant takes place, the greater the success4,5.

How Is the Donated Kidney Implanted into the Recipient?

An incision is made to the patient’s flank area where the surgeon will implant the new kidney. The new kidney is positioned above the pelvic bone and below the existing non-functioning kidney, by suturing the kidney artery and vein to the patient's iliac artery and vein4,5.The final step involves attaching the urethra of the new kidney to the recipient’s bladder4,5.

The key advantage in transplanting a living kidney is that it starts working immediately after transplantation, whereas a deceased kidney can be slow to function 4,5.

One of the most common challenges for potential living donors is that they find they are not an acceptable match for their intended recipients’ blood type. In Part 3 of this article, we will discuss a brilliantly creative solution for this very common dilemma.

References:
1. United Network of Organ Sharing Data: www.UNOS.org/data
2. Alliance for Paired Donation (APD) www.paireddonation.org/donor-info.htm
3. UCSF Medical Center Transplant Service, Becoming a living kidney donor. Question and Answer Pamphlet.
4. University of Southern California Department of Surgery. Kidney Transplant Program. http://www.kidneytransplant.org/
5. Answers.com. Medical Encyclopedia: Kidney Transplantation
*To document your decision and ensure no one will over-ride it, visit www.donatelife.net

About the Author: Risa Simon is a certified management consultant, professional speaker and published author who inherited a rare cystic kidney condition that has positioned her among the many in need of a kidney transplant. After observing family members and friends with PKD struggle with dialysis and unrealistic waitlists (and started to experience her own challenges in trying to find a compatible donor), she decided to join a movement to increase awareness in the humanitarian call for “living” and “paired” donation. For more information contact risasimon@cox.net.

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