My kid­ney for a stranger

Los Angeles Times - - OP-ED - t is ex­tremely By Terry Wood Terry Wood is a neuro-oph­thal­mol­o­gist in Port­land, Ore.

Iun­likely any­one you know will ask you to do­nate a kid­ney. So don’t worry, you’re safe. Or are you? It is ex­tremely likely that some­one you know needs a new kid­ney, and that means some­one in your life needs you to do­nate one.

I met B and her mother two years ago. I am a doc­tor, and they were re­ferred by an­other physi­cian. B had re­ceived a kid­ney from her fa­ther at the age of 2, to ad­dress re­nal in­suf­fi­ciency caused by a con­gen­i­tal con­di­tion. Her orig­i­nal trans­plant was stun­ningly suc­cess­ful. But in young pa­tients, trans­planted kid­neys do not last for­ever. By the time I met B, she was a teenager, and her trans­planted kid­ney’s run was com­ing to its in­evitable end. Re­nal in­suf­fi­ciency was caus­ing an oc­u­lar con­di­tion that threat­ened her vi­sion. She was los­ing vi­sion, and re­nal dial­y­sis would be the next step. She was go­ing down­hill in ev­ery way pos­si­ble.

About a year af­ter B be­came my pa­tient, her trans­planted kid­ney failed. Dial­y­sis fol­lowed. B’s mother could not do­nate a kid­ney. B had no siblings. And her fam­ily’s search for a donor was un­suc­cess­ful. So I vol­un­teered.

Af­ter a blood test, uri­nal­y­sis and a CT scan, I learned that I would not be a good match. B prob­a­bly would re­ject my kid­ney. Some­where be­tween vol­un­teer­ing to be a donor and be­ing in­formed that I was not a match, my courage and conviction fal­tered. Had I been a match, I would have pro­ceeded with the do­na­tion. But I was not. It’s dif­fi­cult to con­fess, but on some level, I was re­lieved. I had done my duty by vol­un­teer­ing, but ul­ti­mately I had not been called to ser­vice. I could there­fore rest easy, telling my­self I had done ev­ery­thing pos­si­ble.

But in my heart, I knew I had not: I had not vol­un­teered to par­tic­i­pate in a donor ex­change.

Donor ex­changes are pro­grams in which a donor who can­not do­nate di­rectly to a pa­tient he or she knows in­stead do­nates to a dif­fer­ent pa­tient, and some­one who wants to do­nate to that sec­ond pa­tient, but can­not, do­nates to the first pa­tient. A chain is es­tab­lished in which pairs of donors and re­cip­i­ents are matched, so that ev­ery­one who needs a kid­ney gets one, and it is the best pos­si­ble kid­ney for each re­cip­i­ent.

Sounds great, right? Prob­lem solved? Un­for­tu­nately not. It seems that peo­ple, my­self in­cluded, are far more will­ing to do­nate a kid­ney to some­one they know over some­one they don’t. We want the al­tru­is­tic plea­sure of know­ing the re­cip­i­ent, and per­haps the plea­sure of know­ing that the re­cip­i­ent knows us.

Months passed. I left the area to do re­search up north. B trans­ferred to the UCLA trans­plant pro­gram. Even­tu­ally, I re­ex­am­ined my de­ci­sion not to par­tic­i­pate in a donor ex­change. I came to the con­clu­sion that I was self­ish and fear­ful. I de­cided that I did not want to be these things. I de­cided to ac­cept the re­al­ity that B needed a new kid­ney, and that if no one else was able to do­nate one to an ex­change, I would.

A month af­ter surgery, B’s new kid­ney is work­ing great. She looks and feels like a dif­fer­ent per­son. Her vi­sion has im­proved. I was a lit­tle sore for the first cou­ple of weeks, but I’m now back to nor­mal. Ac­tu­ally, I lost a few pounds and have started ex­er­cis­ing. I’m stronger than I was be­fore the surgery.

There are many rea­sons to do­nate, or per­haps many man­i­fes­ta­tions of a sin­gle rea­son: The things we do now will echo in eter­nity, as Mar­cus Aure­lius tells us. Kid­ney do­na­tion ex­em­pli­fies this con­cept per­fectly. Per­son­ally, I did it for love. I love all my pa­tients, even if oc­ca­sion­ally I do not like them. By ex­ten­sion, I love any­one who is able to help one of my pa­tients. This means ev­ery­one on the UCLA kid­ney trans­plant team. And it means my coun­ter­part in the donor ex­change pro­gram, a per­son I may never meet, but who was will­ing to do some­thing ex­tra­or­di­nary for some­one he or she loved.

If you want to do­nate a kid­ney, there are donor ex­change pro­grams that will as­sist and stand by you ev­ery step of the way. Do not wait to be asked. The re­quest prob­a­bly will never come.

Jon Con­rad For The Times

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