My best friend Theresa and I met at her overnight birthday party in eighth grade. From the moment I yelled, “Surprise,” a bond was formed that began with stealing our friends’ Maidenform bras (and hiding them in the freezer) and continued for 40 years.
Her mother, who had inherited polycystic kidney disease (PKD) from her dad, suffered renal failure after Theresa was born and was required to dialyze on an artificial kidney machine for eight hours a day, two to three times per week. By the time she was in college, Theresa knew that she had inherited PKD as well.
Most of us are born with two kidneys, excretory organs the size of your fist that filter waste products such as urea and extra water from the blood. Kidneys recycle useful minerals, including sodium and potassium, back into the bloodstream and release hormones that regulate blood pressure, stimulate red blood cell production and maintain calcium levels. In persons with PKD, cysts grow in the kidneys, gradually replacing the tissue, leading to a loss of kidney function and possible renal failure.1
Since her diagnosis, Theresa has managed her disease through a strict diet and disciplined exercise regime, which slowed the cyst growth and the consequent decline in her kidney function. In August 2006, however, her kidney function dropped to 20% of normal and she was put on the national kidney transplant registry. By December 2007, her kidney function had dropped to 10% and it was time for her to either begin dialysis or receive a transplant. When her husband was ultimately eliminated as a potential kidney donor, I volunteered to give her one of mine.
Donor Screening
Our transplant was handled by the Organ Transplant Program at Swedish Medical Center (all of the team are totally fabulous, by the way). Potential kidney donors are screened for general health problems, with particular attention paid to the risk of developing diabetes or heart or kidney disease. Over several months, I spent about 12 hours at Swedish undergoing various tests: blood and urine analysis, chest X-ray, electrocardiogram and, finally, a computed tomography angiography (CT scan) to study my urinary tract, kidney and its blood vessels.2
Donors and recipients must have compatible blood types. A person who is type O can donate to all the other blood types, for example. (Theresa, her husband and I are all type A, although Theresa is A negative and her husband and I are A positive.) The blood sera of the donor and the recipient are mingled (cross-matched) to see if the recipient has antibodies that react with the donor cells. Tissue typing (another blood test) looks at six important proteins/antigens in the blood cells to see how many match. (Theresa and I did not have any protein matches among the six codes — not a problem.)
Donors also meet with a social worker to discuss the motivation for the donation and the impact the surgery might have on the family. Donors do not pay for the medical expenses associated with the testing or surgery; the recipient’s insurance and the Organ Transplant Program pay for those costs.
Because a donor may be unable to work for up to six weeks following the surgery, there can be a financial impact, however, due to lost wages. The Transplant Program provides three months of follow-up care after surgery and covers any requested lab costs.
Why Living Donation?
Thirty years ago, living donations came primarily from relatives (siblings, parents or children) because of the importance ascribed to tissue matching. Today, because of advances in the development of immunosuppressant medications, the risk of kidney rejection is much lower. More and more, living donors are spouses, friends and even anonymous members of the community. Statistically, kidneys from living donors last longer and begin functioning more quickly than kidneys from cadaver donors.3
Like many of you, I checked the organ donor box for cadaver donation the last time I renewed my driver’s license. Unfortunately, the supply of organs from cadaver donors does not come close to filling the needs of the thousands on the national list for organ transplants.
According to the National Kidney Foundation,4 as of April 2007, 70,870 U.S. patients were waiting for a kidney transplant; in 2006, there were only 17,092 kidney transplants — 6,433 from living donors and the rest from cadaver donors. Offering a kidney to Theresa may have saved her from an additional two to 10 years on the transplant list waiting for a match.
Our operations took place on February 25. My surgeon, who specializes in removing donor kidneys, used a laparoscopic procedure to make several small incisions in my abdomen. He inserted the surgical instruments and camera, skirted my large intestines and used the tools to extract my left kidney, portions of the renal artery, vein and the ureter.
After the kidney was cleaned off and iced down, my surgeon handed it off to Theresa’s surgeon, who specializes in implanting kidneys. Her surgeon made an 8-inch incision in the left side of her abdomen, tucked the kidney into her pelvis, and connected the blood vessels to the iliac artery and vein, and the ureter to her bladder. Within 30 minutes of being implanted, my kidney began pumping in Theresa.
Our Prognoses
Very good, on both counts. No offense to our fabulous surgical teams, but, truthfully, the surgery really hurt. (I liken it to having been practice dummies for sushi chefs. But really nice sushi chefs.) The procedures went perfectly, the follow-up care has been great and all of the staff have been exceptional.
During our recoveries, we have both been very tired and our stamina has fluctuated wildly on a daily basis. I was able to go back to work on a limited basis after three weeks. In the future, I need to avoid any extreme contact (football, martial arts or major car accidents) that might damage my remaining kidney and should only use acetaminophen-based pain relievers.
Theresa was able to leave the hospital after about a week. She has been taking medications to suppress her immune system since the day of her surgery and had to socially distance herself from people, germs, dirt and airborne infectious matter for at least two months, when she could go back to work. By three months, her immune system would be back up to about 75% of normal.
For the rest of her life, she will have to take immunosuppressant medications, which will allow her to lead a normal life, but will have some side effects. She also must stay away from grapefruit and star fruit (apparently they enhance the effects of some of her medications). We think the new kidney may extend her life (before needing dialysis or another transplant) from 10 to 15 years (but we are hoping for 25!).
What You Can Do (and Why We Wrote the Article)
Sign up to be a cadaver organ donor and communicate those wishes to your next of kin. The National Kidney Foundation estimates that about 35% of potential donors do not become donors because the next-of-kin do not give permission.5
Consider being a living organ donor. Take it from me, especially if you work with the staff at Swedish, the operation and recovery will go well, the medical team is top notch and the food is great!
A final note: Neither of us could have done this without the support of our families and friends — spouses, kids, parents, in-laws, co-workers. They played an incalculable role and deserve all of our thanks. For more information about living kidney donation, please contact the Organ Transplant Program at Swedish Medical Center at 206-386-3660 or 1-800-996-7426.
Julie Gardner (donor) is a former Foreign Service officer for the U.S. State Department and the assistant to the executive director of the King County Bar Association. If you wondered why she was out of the office for a month recently, now you know. Theresa Luhman (recipient) is the treatment supervisor at Stillwater Therapeutic Services in Kalispell, Montana, where she works with emotionally disturbed children.
1 “Your Kidneys and How they Work,” National Kidney and Urologic Diseases, Information Clearinghouse (NKUDIC), NIH Publication No. 07–3195, August 2007, http://kidney.niddk.nih.gov/kudiseases/pubs/yourkidneys/.
2 The following information is borrowed liberally from “Donating a Kidney: An Informational Guide,” Swedish Medical Center, 2006, www.swedish.org.
3 National Kidney Foundation, http://www.kidney.org/news/newsroom/fsitem.cfm?id=30.
4 Id.
5 Id.
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