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What Are the Risks of Kidney Donation?

When Cameron Drake’s kidneys failed unexpectedly, he didn’t have to look far for a donor. In late October, his mother’s left kidney was removed and transplanted into Cameron at VCU Health’s Hume-Lee Transplant Center in Richmond, Virginia.

Although the decline in his kidney function that ultimately precipitated the need for a new kidney occurred over some time, it wasn’t until the 25-year-old experienced severe symptoms early this year that he even knew he had kidney problems at all. “I started having headaches and nausea and vomiting just about every day. And it got worse and worse, and I didn’t really think anything of it because I just thought it was the stress of a new job and stuff like that,” says Cameron, who landed in the emergency room. Testing showed the problem: “My kidney function was 13 percent,” recalls Cameron, who — like his mother, Kimberly Drake — lives in Powhatan, Virginia. Clinicians told him that his kidney failure was the result of an autoimmune disorder called IgA nephropathy that had attacked his kidneys.

Although he was started on dialysis this summer, it was clear from the early going that he needed a kidney transplant. In general, while many patients remain indefinitely on dialysis — where machines do some of the work of healthy kidneys, like cleaning toxins from blood — research shows patients see substantial improvement with transplantation. “The data is very clear that if you need a kidney transplant, your life expectancy will be significantly longer if you receive a kidney transplant rather than if you stay on dialysis,” says Dr. Marlon Levy, a professor of surgery and chair of the division of transplantation at VCU Health. That’s in addition to a greatly improved quality of life that’s reported by the patient who, if not for the kidney transplant, would otherwise typically require dialysis several times per week for several hours at a time.

[See: 5 Ways to Reduce Your Risk of Developing Kidney Disease.]

However, there’s a critical gap between supply and demand, with more than 95,000 people currently on the waitlist for a kidney in the U.S. That’s according to regularly updated Organ Procurement and Transplantation Network data published by the United Network for Organ Sharing, a nonprofit that manages the nation’s organ transplant system. In 2017, there were nearly 20,000 kidney transplants — counting organs from living and deceased donors. The vast majority of the patients on the waitlist don’t get a transplant in the average year, says Dr. Joseph Vassalotti, chief medical officer for the National Kidney Foundation.

Many die waiting for an organ.

For Cameron, support was abundant. Along with prayers, around two dozen members of his church volunteered to see if they would be a good match to donate a kidney to him, Cameron’s mother Kimberly says. Ultimately, his parents decided, in consult with his doctors, that Cameron would be best served to receive a kidney from close family. Blood type matches and shared human leukocyte antigens, or HLA — protein markers used to determine how closely tissues match — “play vital roles in determining the compatibility and success of a kidney transplant. These can certainly align to varying degrees when a donor and recipient are closely related, which may positively impact the success and longevity of the organ,” explains Dr. Anne King, medical director of Hume-Lee’s kidney and pancreas transplant program and professor of internal medicine and surgery. “However, similarly good outcomes can also occur with donors and recipients who are not related.” After going through a careful evaluation that took into account her overall health, Kimberly donated her kidney.

“I don’t know how to put it into words,” Cameron says. “It means everything to me that she was able to do that and she was willing to do that.”

Since he underwent the transplant just a little over a month ago, Cameron — a biomedical technician coincidentally tasked with maintaining and repairing dialysis machines — hopes to return to work in January. “I feel good. I can definitely feel a difference,” he says. “My energy is a little higher. I have more motivation to get out of bed. I’m not as tired throughout the day.” His hemoglobin (a protein in red blood cells that carries oxygen) and iron levels are still a little low, but are expected to rise, and the transplant procedure and follow-up has gone well, he says. He takes various medications — to keep his body from rejecting the new organ — as well as to control high blood pressure, but takes it all in stride given his drastically improved outlook. “I definitely feel a lot better as time goes on,” Cameron says.

His mom, too, is doing well. “I feel great,” says Kimberly, who was quick to return to an active lifestyle after the procedure.

While receiving a donated kidney can extend a person’s life, giving one away doesn’t appear to decrease the donor’s life expectancy, though there are some risks associated with being a living donor.

Clinicians break those down into short-term and long-term risks. Advances have reduced incision size, made the procedure less invasive and helped speed recovery; still, it’s surgery. “The risk of dying from the operation is exceedingly low,” Levy says — noting data shows it’s anywhere from 1 in 3,000 to 1 in 6,000. “It’s never 0 for major medical procedures, and I think you have to treat kidney donation as a significant medical procedure.” Apart from that, other risks associated with surgery apply, such as the possibility of infection.

[See: 10 Tips for Promoting a Healthy Bladder.]

“Some donors have reported long-term problems with pain, nerve damage, hernia or intestinal obstruction,” according to the National Kidney Foundation. “These risks seem to be rare, but there are currently no national statistics on the frequency of these problems.” What’s more, people with a single kidney may be at greater risk for developing high blood pressure, proteinuria — or having a significant protein in their urine, which may indicate kidney damage — and reduced kidney function. A 2018 review of research published in the Annals of Internal Medicine also speaks to risks of donation, including of end-stage kidney disease, while noting such risks are low.

“There is a small risk of increase in blood pressure after many years,” Vassalotti says. There’s also a “significant risk — but again it’s very, very small — of developing kidney failure. There’s a small number of patients who develop kidney failure after donation, and those patients are treated in a very special way by the transplantation system,” he says. “They have the highest priority for receiving a transplant.”

Women who donate a kidney and then become pregnant are at increased risk of developing preeclampsia — a complication of pregnancy characterized by high blood pressure — although the relative risk is still low.

Given the need for kidney donation, clinicians say living donors should be commended — whether donating to a loved one, as is often the case, or to someone they don’t know personally. “Donating a kidney to be able to help somebody else is a heroic act,” Levy says. “I don’t think there’s any other way to describe it.” (It’s also urged that people make their intentions known to loved ones for deceased organ donation.)

Still, it’s important to talk with a transplant team not only to undergo a comprehensive evaluation to ensure one is healthy enough for donation, but to get a better sense of one’s individual risks. For those who donate a kidney, experts also urge follow-up visits, as prescribed, after the procedure to monitor one’s health.

Along with checkups following surgery with the transplant team, it’s important to keep one’s regular health provider, like a primary care provider, in the loop to check for issues like high blood pressure over the long term. In some cases it may help to see a specialist, too. “If long-term complications develop, or they’re difficult to manage, I think certainly it would be reasonable that a nephrologist would be involved,” Vassalotti says.

The evaluation of potential donors considers not only medical factors that might disqualify donation — ranging from whether a person has diabetes or heart disease to any signs of kidney disease — but a person’s reasons for wishing to donate, and mental health as well, says Dr. C.S. Krishnan, an associate professor of transplant surgery at Sacramento, California-based UC Davis Health. The aim is to ensure a person is ready for donation, physically and mentally, and that they have the support they need afterward. “The key again when you do the evaluation for the donor is to make sure that when a patient’s left with one kidney that is enough to sustain them lifelong,” Krishnan says. “So that’s why the evaluation is so rigorous.”

[See: 10 Lessons From Empowered Patients.]

Kimberly and Cameron encourage others to consider donation as well. “What if I donate my kidney to Cameron and then … my kidney fails, what am I going to do?” she recalls thinking. “That did cross my mind.” But any doubts she may have had about donating her kidney to her son didn’t last. Along with her desire to help Cameron, and the sheer need for kidney donation she witnessed firsthand in taking him to dialysis, her faith — and the support of others praying for her and Cameron — strengthened her resolve and gave her a sense of peace. “We prayed and prayed and knew that God has laid all this out for us and that I would be the donor,” she says. “So I quit worrying about it.”

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What Are the Risks of Kidney Donation? originally appeared on usnews.com



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