Living Donor Risks Living Kidney Donor

Another NY Times living kidney donor transplant article, all about the recipient

Nina Bernstein this time, celebrating that undocumented immigrant Angel finally got his kidney transplant. His living donor wasn’t his wife, but his brother, who is ALSO an undocumented immigrant.

As with Mr. Kevin Sack, I sent her an email through the NY Times website. Since I’ve yet to hear a peep from Kevin, I don’t expect a different result here. But we advocates, we just keep trying, right?



Ms. Bernstein:

I understand your attempt to highlight the legal hurdles of an undocumented immigrant receiving potentially life-saving health care (although a transplant is NOT a cure, and Angel will be on expensive medication the rest of his life at the taxpayer expense), but what about his equally undocumented immigrant brother? A kidney is not a pint of blood, he has been exposed to untold short and long-term risks, and exactly who will be there to care for him?

According to OPTN, 4.4 living kidney donors die each year in the US within 12 months of surgery.

20% experience complications: nerve damage, pancreatitis, intestinal blockage, hernia, testicular swelling requring surgery, adrenal dysfunction, chronic fatigue, etc.

20-30% suffer from depression, anxiety, anger, PTSD, financial or other psychosocial issues post-donation. Not a single transplant program offers aftercare or support.

There are NO NATIONAL STANDARDS of evaluation, selection, or treatment for living donors. Each program makes up their own policies (none of which are based on clinical evidence) and they are accountable to no one.

There is NO SHORT OR LONG-TERM DATA on living donors. No one even bothered to collect a social security number until 1994, omitting 40 yrs of LDs. All published studies have been single center, small sample sizes, and rife with selection bias and validity problems.

In 2000, the Secretary of Health mandated One year of follow-up on all LDs (two years as of 2006). A decade later, 30% are still reported ‘lost’ by one-year. In 2009, OPTN’s own data task force concluded the database to be ‘woefully inadequate’ and ‘useless’ for analysis or research.

The remaining kidney does not ‘grow’ but hypertrophies, which means the cells actually swell under the increased pressure of doing double the work. This makes the kidney more vulnerable to disease, toxins or damage. Think of what happens to a balloon when air is blown into it.

A 10% reduction in kidney function has been proven to significantly increase one’s cardiovascular risk (Tonelli 2007), and living kidney donors lose approximately 30%. This means a higher lifetime risk of hypertension, cardiac disease and death, and kidney disease and death. Since 1994, 300+ kidney donors have been waitlisted in need of their own kidney transplant, approximately 20 years post-donation. A scarier prospect is that the vast majority of those in early stages of kidney disease (GFR < 80, which includes all LKDs) will never progress to kidney failure because they’ll die of a cardiac event first (Brenner 2008).

Ron Herrick, the world’s very first LKD, suffered a stroke in 2002, was on dialysis the last years of his life, and died shortly after cardiac surgery in 2010.

As the sister of a kidney recipient, and friend of a heart recipient, I understand the importance of donor organs and transplants. But as a living kidney donor and activist, I find the constant perspective of LDs as nothing more than an afterthought completely unethical and abhorrent. The public should never be regarded as medical supply. Living donors are people too, and we deserve the same care and respect as our recipient.

Cristy Wright, M.Ed.