Becoming a living donor is a voluntary decision by a family member or friend of the
potential recipient.
It may also be the choice of a caring stranger.
About half of the transplants performed in the United States come from living donors.
Living donation has become the gold standard for kidney transplantation in the United States.
A living donor advocate will work with you through each step of the process.
Thomas Waid, MD is here today to answer your questions about the living donor program at UK HealthCare.
Learn more about being a living donor
Becoming a Living Donor: You Can Help A Family Member or A Stranger
From the Show: UK HealthCast
Summary:
Air Date: 8/17/15
Duration: 10 Minutes
Transcription:
Melanie Cole (Host): The decision to become a living donor is a voluntary choice and should involve careful consideration. My guest today is Dr. Thomas Waid. He is the Medical Director for Renal and Pancreas Transplantation Program at the University of Kentucky Healthcare. Welcome to the show, Dr. Waid. Tell us a little about living donation. What are some of the advantages and what’s involved?
Dr. Thomas Waid (Guest): Living donation is one of the ways that we can actually treat loss of kidney function or renal failure. Of course, there are the treatment modalities of dialysis, hemodialysis and peritoneal dialysis but they have lifestyle and medical limitations. Donation of a kidney, either through a deceased donor or a live donor, restores kidney function and allows the recipient to go through a much more normal life than they would have on dialysis. In the case of living donation, we look for people who are very altruistic and who really want to give a gift that is a gift of life to patients who have suffered from kidney disease. The donation of the organ really gives that recipient a much better lifestyle and less risk of complications of cardiovascular disease that patients on dialysis get. In fact, if you look at the overall survival, your risk of having a bad cardiovascular event on dialysis is about 9% per year; whereas, after transplantation, it’s about 0.9% per year. So, there is a ten-fold reduction and these patients have much better lifestyles and are much more cardiovascular risk free. Now, that’s not to say that there aren’t problems with organ transplantation of any type because if you suppress the immune system of the patient to reduce the risk of rejection, then you run into problems down the road with infections or with cancer over a long period of time but this is usually years down the road. Again, the patient who receives the organ transplant has a much better lifestyle and a much better survival overall than if they have to undergo dialysis.
Melanie: Dr. Waid, tell us about becoming a living donor. What are donors typically age-wise and health and what can they expect from that initial evaluation? What are you looking for from them?
Dr. Waid: Well, the donors are generally in the age range of 18 to about 60 years of age. Of course, the older the potential donor is, the more likelihood that there might be a problem with overall organ function or decline in overall organ function. We evaluate those patients very, very carefully to make sure that number one, if they donate no harm will come to the donor. That’s very, very key. Because the recipient does get a benefit but we want to make absolutely sure that the donor who is giving up an organ, and as I said, again, this is very altruistic--an act of love, so to speak – is not harmed in any way during the process of donation. That their kidney function will continue to be good and they won’t have any problems with their overall lifestyle. They should go on as if it never happened after a few days or a few months of recuperating from the operation. The donors, generally, are motivated to come forward and ask about donation. This may be because a family member has suffered from kidney disease and they are adequately matched as a potential donor for that potential recipient. Or, we have altruistic donors who call up and want to donate and don’t necessarily even know patients that are out there who may need a kidney. Also through social media, we are finding a lot of people who are coming forward to be evaluated as donors because they’ve seen somebody on Craigslist or they’ve seen someone on Facebook or they’ve seen an advertisement. We have patients who have actually put up requests for possible donation. They’ve asked in church, etc. So, potential donors get information from all different sources now. It doesn’t necessarily just have to be a family member who has a relative who is affected by kidney disease. Generally speaking, these people have to be in relatively good health. They can’t have cardiovascular disease. They can’t have too much of a weight problem. They can’t be diabetic. They can’t have anything that is infectious that could be passed on such as hepatitis or HIV. Those patients are really screened both medically and through our social workers psychosocially and have to be fit to be potential donors. Then, we go from that point on. If, at any time, the person who wants to be donor decides that this is really not for them and they want to change their mind, they’re certainly within their rights to withdrawal that process. Because, again, there should never be any pressure on any person who wants to be considered as a donor. There should never be any coercion. We make absolutely sure that we have advocates for donation. We have separate nephrologists who screen them. We have separate social workers and we have separate donor advocates that keep apart the patient that wants to be the recipient versus the person who wants to be the donor. They are taken care of by different medical teams so there can never be any conflict of interest among the two teams evaluating the potential donors and recipients.
Melanie: Dr. Waid, when someone decides this with the liver, this can regenerate if they give a piece of their liver, but when they give a kidney that’s permanent. What do you say to people who want to donate but they’re worried about what if one day that one kidney that they still have now fails or that they are going to need one in the future? That giving away one kidney is something that you will never get back and can you live with one kidney?
Dr. Waid: Yes, you can live with one kidney. Certainly, in his infinite wisdom when the Good Lord created animals, he built in a lot of redundancy within organ systems and the kidney has a lot of redundancy. In fact, kidney failure really occurs when you’ve lost about 90% of all of your kidney function. When you give up one kidney, you get a reduction of the kidney mass by 50% but the blood flow then all goes to the other kidney and the other kidney takes over a lot of that extra work and actually it takes up more than just a 50% loss of function. There are a lot of people walking around on the face of the earth who are born with just one kidney. They do quite well and their risk of losing that kidney is not necessarily any greater than if they had two kidneys. Now, do people who donate lose kidney function? Yes, that sometimes happens. People who donate earlier on in life can later on develop things, medical illnesses such as diabetes, etc., which can cause a loss in kidney function. In fact, we have one patient in our particular group who actually donated years ago to a family member and subsequently developed diabetes down the road and lost kidney function because of that. We wound up transplanting that person. The United Network for Organ Sharing which is our national organization gives priority for patients who have been previous donors to receive an organ if that does occur. But the chance of that happening is very, very small. I’ve done this for 30 years now and I’ve only known that to be the case in two patients out of the several thousand that we’ve transplanted since I’ve been here. So it does occur, but it is a very small risk.
Melanie: In just the last minute, Dr. Waid, and we don’t have a lot of time and it’s such a great, great topic and, as you said, altruistic. It’s really a very difficult decision to make. Please give the listeners your best information; what you really want them to know about living organ donation and about the living donor program at U.K.
Dr. Waid: Living donation really gives some advantages even over being on a donor list. The overall kidney function is usually better. The kidney graft lasts overall a lot longer period of time. The risk of staying on a waiting list and developing cardiac complications is fairly high and the living donation process shortens that time to transplantation considerably and then decreases the cardiovascular risk. It is really the best type of transplantation that we have now. It has been for many, many years. We have an overall shortage of organs for patients who need transplantation. If you take a look at the overall numbers of patients of all types who need organ transplantation, it is around 120,000 in this country. We will transplant only about a fifth of that because of the number of organs available. If people would really consider the process of organ donation and transplantation and as the Kentucky court clerks did years ago, sign your driver’s license. Be a willing donor. Talk amongst your family members and really consider this in terms of organ and tissue donation. I think it would help decrease the national shortage. And get a lot of people who are very sick from end organ failure back on the track of a more reasonable life and a more reasonable lifestyle. They can be more productive for society because their end stage organ failure has really held them down in a very disabled position. So, I think that’s where we’re coming from with live donations, especially in organ transplantations of all kinds in general.
Melanie: Thank you so much, Dr. Waid. You're listening to Advances and Insights with U.K. Healthcare in Lexington, Kentucky. For more information, you can go to UKHealthcare.UKY.edu. That's UKHealthcare.UKY.edu. This is Melanie Cole. Thanks so much for listening.
Melanie Cole (Host): The decision to become a living donor is a voluntary choice and should involve careful consideration. My guest today is Dr. Thomas Waid. He is the Medical Director for Renal and Pancreas Transplantation Program at the University of Kentucky Healthcare. Welcome to the show, Dr. Waid. Tell us a little about living donation. What are some of the advantages and what’s involved?
Dr. Thomas Waid (Guest): Living donation is one of the ways that we can actually treat loss of kidney function or renal failure. Of course, there are the treatment modalities of dialysis, hemodialysis and peritoneal dialysis but they have lifestyle and medical limitations. Donation of a kidney, either through a deceased donor or a live donor, restores kidney function and allows the recipient to go through a much more normal life than they would have on dialysis. In the case of living donation, we look for people who are very altruistic and who really want to give a gift that is a gift of life to patients who have suffered from kidney disease. The donation of the organ really gives that recipient a much better lifestyle and less risk of complications of cardiovascular disease that patients on dialysis get. In fact, if you look at the overall survival, your risk of having a bad cardiovascular event on dialysis is about 9% per year; whereas, after transplantation, it’s about 0.9% per year. So, there is a ten-fold reduction and these patients have much better lifestyles and are much more cardiovascular risk free. Now, that’s not to say that there aren’t problems with organ transplantation of any type because if you suppress the immune system of the patient to reduce the risk of rejection, then you run into problems down the road with infections or with cancer over a long period of time but this is usually years down the road. Again, the patient who receives the organ transplant has a much better lifestyle and a much better survival overall than if they have to undergo dialysis.
Melanie: Dr. Waid, tell us about becoming a living donor. What are donors typically age-wise and health and what can they expect from that initial evaluation? What are you looking for from them?
Dr. Waid: Well, the donors are generally in the age range of 18 to about 60 years of age. Of course, the older the potential donor is, the more likelihood that there might be a problem with overall organ function or decline in overall organ function. We evaluate those patients very, very carefully to make sure that number one, if they donate no harm will come to the donor. That’s very, very key. Because the recipient does get a benefit but we want to make absolutely sure that the donor who is giving up an organ, and as I said, again, this is very altruistic--an act of love, so to speak – is not harmed in any way during the process of donation. That their kidney function will continue to be good and they won’t have any problems with their overall lifestyle. They should go on as if it never happened after a few days or a few months of recuperating from the operation. The donors, generally, are motivated to come forward and ask about donation. This may be because a family member has suffered from kidney disease and they are adequately matched as a potential donor for that potential recipient. Or, we have altruistic donors who call up and want to donate and don’t necessarily even know patients that are out there who may need a kidney. Also through social media, we are finding a lot of people who are coming forward to be evaluated as donors because they’ve seen somebody on Craigslist or they’ve seen someone on Facebook or they’ve seen an advertisement. We have patients who have actually put up requests for possible donation. They’ve asked in church, etc. So, potential donors get information from all different sources now. It doesn’t necessarily just have to be a family member who has a relative who is affected by kidney disease. Generally speaking, these people have to be in relatively good health. They can’t have cardiovascular disease. They can’t have too much of a weight problem. They can’t be diabetic. They can’t have anything that is infectious that could be passed on such as hepatitis or HIV. Those patients are really screened both medically and through our social workers psychosocially and have to be fit to be potential donors. Then, we go from that point on. If, at any time, the person who wants to be donor decides that this is really not for them and they want to change their mind, they’re certainly within their rights to withdrawal that process. Because, again, there should never be any pressure on any person who wants to be considered as a donor. There should never be any coercion. We make absolutely sure that we have advocates for donation. We have separate nephrologists who screen them. We have separate social workers and we have separate donor advocates that keep apart the patient that wants to be the recipient versus the person who wants to be the donor. They are taken care of by different medical teams so there can never be any conflict of interest among the two teams evaluating the potential donors and recipients.
Melanie: Dr. Waid, when someone decides this with the liver, this can regenerate if they give a piece of their liver, but when they give a kidney that’s permanent. What do you say to people who want to donate but they’re worried about what if one day that one kidney that they still have now fails or that they are going to need one in the future? That giving away one kidney is something that you will never get back and can you live with one kidney?
Dr. Waid: Yes, you can live with one kidney. Certainly, in his infinite wisdom when the Good Lord created animals, he built in a lot of redundancy within organ systems and the kidney has a lot of redundancy. In fact, kidney failure really occurs when you’ve lost about 90% of all of your kidney function. When you give up one kidney, you get a reduction of the kidney mass by 50% but the blood flow then all goes to the other kidney and the other kidney takes over a lot of that extra work and actually it takes up more than just a 50% loss of function. There are a lot of people walking around on the face of the earth who are born with just one kidney. They do quite well and their risk of losing that kidney is not necessarily any greater than if they had two kidneys. Now, do people who donate lose kidney function? Yes, that sometimes happens. People who donate earlier on in life can later on develop things, medical illnesses such as diabetes, etc., which can cause a loss in kidney function. In fact, we have one patient in our particular group who actually donated years ago to a family member and subsequently developed diabetes down the road and lost kidney function because of that. We wound up transplanting that person. The United Network for Organ Sharing which is our national organization gives priority for patients who have been previous donors to receive an organ if that does occur. But the chance of that happening is very, very small. I’ve done this for 30 years now and I’ve only known that to be the case in two patients out of the several thousand that we’ve transplanted since I’ve been here. So it does occur, but it is a very small risk.
Melanie: In just the last minute, Dr. Waid, and we don’t have a lot of time and it’s such a great, great topic and, as you said, altruistic. It’s really a very difficult decision to make. Please give the listeners your best information; what you really want them to know about living organ donation and about the living donor program at U.K.
Dr. Waid: Living donation really gives some advantages even over being on a donor list. The overall kidney function is usually better. The kidney graft lasts overall a lot longer period of time. The risk of staying on a waiting list and developing cardiac complications is fairly high and the living donation process shortens that time to transplantation considerably and then decreases the cardiovascular risk. It is really the best type of transplantation that we have now. It has been for many, many years. We have an overall shortage of organs for patients who need transplantation. If you take a look at the overall numbers of patients of all types who need organ transplantation, it is around 120,000 in this country. We will transplant only about a fifth of that because of the number of organs available. If people would really consider the process of organ donation and transplantation and as the Kentucky court clerks did years ago, sign your driver’s license. Be a willing donor. Talk amongst your family members and really consider this in terms of organ and tissue donation. I think it would help decrease the national shortage. And get a lot of people who are very sick from end organ failure back on the track of a more reasonable life and a more reasonable lifestyle. They can be more productive for society because their end stage organ failure has really held them down in a very disabled position. So, I think that’s where we’re coming from with live donations, especially in organ transplantations of all kinds in general.
Melanie: Thank you so much, Dr. Waid. You're listening to Advances and Insights with U.K. Healthcare in Lexington, Kentucky. For more information, you can go to UKHealthcare.UKY.edu. That's UKHealthcare.UKY.edu. This is Melanie Cole. Thanks so much for listening.
