What to Know About Kidney Donation
Lloyd Ratner, MD, Director, Renal and Pancreatic Transplant Program, tells prospective patients, kidney donors, and families what they need to know about kidney donation and transplantation.
Transcript
Hello. I'm Dr. Lloyd Ratner and I'm the Director of Renal and Pancreatic Transplantation here at Columbia University New York Presbyterian
Hospital. In this video, I hope to tell you everything you really need to know about donating a kidney. It's our general philosophy
that the more the patient knows, ultimately the better they're going to do. Let's start from the very beginning. In terms of
the recipient. The recipient is best served and will do better if they're able to get a live donor kidney as opposed to a deceased
donor kidney or staying on dialysis. Now in terms of kidney transplantation versus dialysis, the advantages of kidney transplantation are,
number one, the recipient could live longer and in general, the results are
that people in general live about twice as long with a kidney transplant as they would if they had stayed on dialysis.
Number two, they'll feel better. Number three, they'll have more control over their lifestyle and number four, they should be able
to have a more lenient diet. Again the advantages of a kidney transplant relative to dialysis are live longer, feel better, more control
over the lifestyle, and eat better. Now in terms of a live donor versus a deceased donor transplant, a live donor transplant is
better for the following reasons. Number one, the person generally doesn't have to wait on the waiting list and that often enables
recipients to be transplanted preemptively before ever requiring dialysis, and that's a big advantage. Number two, any time we get
a kidney from a deceased donor, there's about a 50/50 chance that the kidney won't function appropriately initially and that makes
the whole post operative course more difficult and a greater risk for complications. With a live donor, the kidney will work appropriately
right from the get go about 95% of the time. So things just go smoother and there's really much less risk for complications with a live
donor transplant. Number three, the risk of rejection usually is a little bit less with a live donor transplant. And number four
and most importantly the long term results are better with a live donor transplant than with a deceased donor kidney transplant. So, if
someone gets a kidney from a deceased donor, there is a 50/50 chance that the kidney will last for ten years or more. If they get a
kidney from a live donor, 50/50 chance that the kidney will last for 20 years or more. And if they're lucky enough to get a kidney
from a perfectly matched brother or sister, 50/50 chance that the kidney will last for 35 years or more. So there is a huge advantage
if people could get a kidney from a live donor versus a deceased donor. So, for all those reasons, we try to encourage live kidney donation,
but that said, we don't wanna create a problem where there isn't one. So, that's why we put the donors through very extensive evaluation
process but what are we looking for in this evaluation process? Well, first, we wanna make sure that the donors don't have any
diseases that they could potentially give the recipient such as things like hepatitis, HIV, cancer, etc. And usually those are
screened by just blood tests. Number two, we wanna make sure that it's safe for the donor to undergo surgery and anesthesia. Number
three, we wanna make sure that long term, the donor is gonna be okay with just one kidney. And then number four, we wanna make sure
that from a psychological standpoint, the donor understands what they're getting themselves into, that they could give an informed
consent, that they are not being coerced, that they don't have any unrealistic expectations
about the whole process. And that if things don't work out for any reason, that they don't become pathologically depressed. And
then finally in terms of the donor, we have them undergo a CAT scan to make sure that they do have two kidneys, that both kidneys are
normal, and that we have a roadmap to do the surgery with. So that's why as a donor you have to go through this whole extensive evaluation
process to make sure it's gonna be safe for everyone involved. Now, if everything checks out okay, it's generally very, very safe
to donate a kidney but that doesn't mean that there is no risk. Worst case scenario, anybody could die from any operation and donating
a kidney is no exception. The chance of dying from donating a kidney is roughly equivalent to the risk of being killed
in a car accident over a one year period here in the United States. Now, I had a fellow say to me once, he was donating to his brother,
he said, well I've been in 13 accidents in the last 10 years. I said well, if that's the case, you're safer on the operating table
than you are in your own car as are the rest of us. So, we don't think twice about getting in the car everyday, but that's about
what the risk of donating a kidney is. Now long term, the risks are so small to a kidney donor, that insurance companies won't
raise their life insurance premiums, they won't raise their health insurance premiums, they won't deny them insurance. And I think
that tells us a lot because we all know an insurance company will never cut anyone a break in paying premiums if they have a valid
excuse to raise the premiums. And in fact, about once a year, once every couple of years, I get
a call from a kidney donor who says their insurance company is giving them a hard time and I've always just written a letter to
the insurance company and it's taken care of it. Now there are even studies that show that living kidney donors actually live
longer than the general population, and it's not that taking out your kidney makes you live longer, it's just that we select out
only the healthiest people to donate their kidney and they remain healthy after they've donated the kidney. And in fact the woman
who conducted one of these studies that have shown this is nephrologist in Sweden who after she conducted this study, she donated a kidney
to her own husband and both she and her husband are doing well, more than ten years after the donation. Of course she did the study
first before she donated to her husband but she donated nonetheless because it is still safe to donate. Now, let's
talk about the operation itself. The operation that we do is called the laparoscopic donor nephrectomy and with a colleague of mine
and I, when I was Baltimore John Hopkins University, we were the first people in the world to perform this operation in February
of 1995, and now it's become the standard of practice throughout the world. The laparoscopic operation uses minimally invasive surgical
techniques, and what we do, is we make several small incisions between a quarter of an inch and a half-inch long. And through one of these
incisions we place a fiber optic TV camera so we could see what's going on on the inside without having to make a big incision. Through
the other small incisions, we place our instruments and when it's time to remove the kidney, we generally make an incision between
two and three inches long right over the pubic bone and remove the kidney through there. The
old way of doing the operation was to make a big incision across the side, put our hands in and take the kidney out through that
big incision. The advantages of the laproscopic operation are, that number one, it hurts less both in terms of how severe the pain
is and also how long the pain lasts. Number two, the hospitalization is shorter, so most people spend about two days in the hospital.
And then number three and most importantly, the recuperation is quicker. So, most people tell us, it takes them roughly about three weeks
to get back to full speed as opposed to six to eight weeks with the older operation with the big incision across the side. Now,
the one catch or caveat to this laparoscopic operation is, is that with any type of laparoscopic surgery, and taking out the kidney
is no exception there's always a possibility that we may need to convert to the bigger incision during the surgery. And if we have to convert to
the bigger incision then you lose the benefit of the laparoscopic operation. So why would we want to do this? Well the answer is
that this is sort of a safety net. So if we were concerned about injuring the kidney, if we were concerned about injuring adjacent
organs like the bowel or the spleen or if there was more bleeding than we had anticipated, those are all reasons to convert to the
larger incision. So we wouldn't know that until we were there in the operating room doing the surgery. And again if we had to convert
you would lose the benefits of the laparoscopic minimally invasive surgery. Now I wouldn't worry too much, the chance of us having to convert
from the laparoscopic to the larger incision is less than 1%. So it's something you need to know but
I wouldn't worry about it very much. Now the operation is done under general anesthesia. What we do is we bring the donor into
the operating room we put them to sleep and start the operation. Somewhere between a half and an hour after we start the donor's
operation, we'll start the recipient operation. So there is a time when both the donor and the recipient are in the operating room
simultaneously but the donor's operation starts first and ends first. It generally takes somewhere between and four hours on average.
When it's all done, the surgeon will come out and speak to the
family in the waiting room. If it's taking longer than three or four hours, family members shouldn't be concerned. You'd much rather
have us take our time and make sure everything is just right, rather than trying to rush through to get done in three or four
hours. Don't worry we'll take good care of the donor, make sure everything goes smoothly. Now, the donor then wakes up in the recovery
room and most donors will have some pain but we'll make sure they get plenty of pain medication. After a few hours in the recovery
room, generally most of our donors go up to the seventh floor and all this takes place in the Milstein Building which is our main
hospital building. The 7th floor is our transplant floor and the recipients will also wind up on the 7th floor so donor and recipient
will be close to one another so that they could visit with one another. Family members could visit easily, etc. But they won't
be in the same room, we keep the donor and recipient in separate rooms. Like I said, most donors spend about two days in the hospital
and when they get discharged they get discharged home with a prescription for narcotic pain medications. Most people tell us that they needed
the narcotic pain medications for between three and four days. And then after that they need over-the counter pain medication
like tylenol, or extra strength tylenol for another three or four days. So in general they need pain medication for somewhere between
a week and 10 days. About a week after being discharged, you'll come back and see your surgeon in the clinic and if everything
is okay at that point, it's not necessary to come back to see us
here at the transplant center for the donor. However, we do make the following recommendation. That at six months, one year and then
every year subsequently, the donor should get a complete history and physical with routine blood and urine tests either by an
internist or their family doctor. If they don't have an internist or a family doctor, or if they'd prefer to, we'd be happy to see
them here. But it's not necessary for the donors to keep coming back to us over the long haul. And the reason for these regularly
scheduled visits at six months, 1 year and then every year subsequently, are to make sure that the donors aren't developing any other medical
problems like high blood pressure or diabetes which could impact on the remaining kidney. Now, the donors aren't gonna be at any
increased risk for developing these things by virtue of donating their kidney but we know that a certain percentage of the population,
as they age will develop these things. So what we wanna do, if someone is developing these problems, we wanna make sure that if they develop
them, they get picked up promptly and treated appropriately to protect that remaining kidney. Once people have recuperated from
the surgery, they should be 100% completely normal. No special diet, no limitation on their exercises,
no special medications, like I said, it shouldn't affect their insurance
status, they should be able to get health and life insurance with normal premiums. There are some instances however where donating
a kidney can have a potential impact and the first is, if the donor is in the military, and this is very variable. It can potentially
affect a military person's active duty status. And that depends
on the branch of the service they're in, their job, their commanding officer, their medical officer, so if someone is a potential donor
and they're interested in donating, and they're in the military, they should discuss this with their commanding officer and medical officer for their particular
unit. The other area where live kidney donation can potentially
have an impact is for women who are of child-bearing age who hope
to get pregnant after they've donated a kidney. Now, we used to always say that donating a kidney should have no impact on the
ability to get pregnant, sustain a pregnancy, have a normal child afterwards. More recently, at an international transplant meeting
in Australia, data was presented that showed some very interesting findings. The first finding is, when they looked at people who
donated a kidney, and who then subsequently got pregnant, and compared
them to women, general population who got pregnant, had babies,
there was risk for things like complications of pregnancy like gestational diabetes, preeclampsia,
low for birth weight babies, prematurity and all that was exactly the same in people who donated their kidneys versus the general
population. So that's good, so there is no increased risk relative to the general population. But what they did is they also went
a step further and they looked at women who had donated their kidneys, who had been pregnant before they donated and then who had been
pregnant after they donated. And when they compared the women from their pregnancies before donation to after donation and they corrected
for age because obviously they were older after they'd donated than they were before they donated. Then the incidence of things like
preeclampsia, low for birth weight babies, prematurity, and things like that, was a little bit higher after live kidney donation.
kidney urinary health
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