Truly give of yourself

There’s a huge need for organ transplants, and donations are now seen as low-risk

WHO’S AT RISK

More than 120,000 Americans are on waiting lists for an organ transplant. “Every day in this country, 17 people die without the opportunity of a transplant,” says Mount Sinai’s Dr. Sander Florman.

“Right now, there are 100,000 Americans waiting for a kidney and 17,000 for a liver,” says Florman. “There are nowhere near enough organs from deceased donors for these people — living donors are the only way we’ll ever be able to match this need.” In 2010, 6,500 organ transplants were performed thanks to living donors.

Since the first living donor successfully gave a kidney to his twin brother in 1954, thousands of living donor transplants have been done in the U.S. and around the world.

“Living donation is a very altruistic thing, but it also challenges the principles of medicine, including ‘First do no harm,’ ” says Florman. “While giving an organ is not risk-free, at this point it is low-risk — living donors often hate the word heroes, but they truly are all lifesavers.”

Recent studies have found that most living donors suffer only minor complications and enjoy emotional benefits that can last the rest of their lives.

A kidney or part of the liver are the organs most commonly given by a living donor. “The kidneys clean the blood of poisons and get rid of it in urine, and the liver has over a thousand functions, like making proteins, metabolizing drugs and fighting infection,” says Florman.

“If your kidneys fail, we can keep you alive with dialysis. But if the liver fails, people either get a transplant or die.”

The most common causes of kidney disease are high blood pressure and diabetes, and most liver disease is due to hepatitis C and fatty liver disease, but dozens of other things can cause these organs to fail.

Historically, most living donors of kidneys have given an organ to a relative or friend, but some donors step forward to help a stranger.

“Because diseases often run in families, it’s not always possible to find a candidate, even if 10 relatives step forward to offer a kidney,” says Florman.

“Paired exchange programs match a kidney from an incompatible pair with a compatible recipient, then that recipient’s incompatible donor can be given to someone else who is compatible, and so on down the line,” he said, describing a system that is coming into frequent use. “A recent chain included 60 people and 30 transplants.”

All donors are intensely screened to check that they are in perfect health and that no coercion or money is involved.

TRADITIONAL TREATMENT

Potential living donors embark on a rigorous screening program, but it starts with a phone call or interview. “The first step is providing a basic health history by answering a questionnaire,” says Florman. “If you have had diseases like cancer or diabetes, you’re likely not an eligible candidate. If you are eligible, we’ll start with simple tests, many of which you can have done near home, to check your blood type and basic lab work.”

Next, donors spend a full day at the transplant center meeting the entire donor team, including psychiatrists and social workers, to make sure there’s no coercion and the donor is fully informed. Ultimately the donor will get tests such as a CT scan to check anatomy.

“When donors change their mind, we’ll give them a medical out and say they were incompatible,” says Florman.

Living donation is an elective surgery, meaning doctors can schedule it at the best possible time and make sure the donor and recipient are in the best health possible.

“Kidney donation can be done through a two- to three-hour minimally invasive surgery,” says Florman. “We can usually detach the kidney bloodlessly, and we time it so that the recipient is immediately ready to receive the kidney, which is out of a body for about 40 minutes.” Donors are home within two days and fully recovered in two weeks.

Liver donation is a more difficult procedure and is not minimally invasive. “We make a very small incision without dividing the abdominal muscles, and the second we start cutting the liver, it starts regrowing — it is truly amazing,” says Florman.

“It takes us about four hours to retrieve a portion of the liver, and we can usually do this with minimal blood loss.” Postsurgery, donors go to the ICU overnight, and usually can go home in five to seven days. “It’s a much bigger surgery than giving a kidney, and the recovery is usually four to six weeks,” says Florman.

“These donors are doing something so spectacular — they are giving the gift of life and health back to the recipient.”

RESEARCH BREAKTHROUGHS

Transplantation is an active field of research on several fronts. “Current research suggests that people who are altruistic become more resilient, in other words, better able to cope with life’s difficulties,” says Florman. “What we’re finding is that it looks like living donors go through life feeling better about themselves because they’ve done this great altruistic thing.”

QUESTIONS FOR YOUR DOCTOR

The question all potential donors want to know is, “Am I really going to be okay in the long term?” “Donating a kidney or part of the liver is not risk-free, but it is low-risk,” says Florman, “Studies have found that living donors go on to live as long as anyone else.”

A common concern for many women is, “Can I get pregnant after this donation?” “The great thing about being a living donor is that you can go on and have a completely normal, healthy life,” says Florman. “Donors go on to have children and even run marathons.”