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Advocacy Informed Consent Living Donor Misinformation Living Donor Protections Living Donor Risks Psychosocial Risks

UPMC’s Hamar Clouds Truth of Living Donation

http://www.pittsburghlive.com/x/pittsburghtrib/news/pittsburgh/s_651813.html

In a recent interview, Dr. Abhinav Humar, University of Pittsburgh Medical Center’s transplant chief stated his intention to increase the use of organs from the living to over 60%. While his motivation to help those with liver and kidney disease should be lauded, it should not come at the expense of another group of healthy people – namely, Live Donors.

Dr. Human is quoted as saying “The live-donor kidney transplant poses few complications for the…donor”. This is a purposely misleading, if not completely disingenuous distortion of the facts.

The Living Organ Donor Network found:

– Post-operative and wound healing complication rate of 23.07%.

– 37.5% complication rate only ONE YEAR post-donation. (Many health-related issues, such as hypertension or severely reduced kidney function will not appear for many years, so this number will only increase.)

The first living kidney donor transplant occurred in 1954, but until 2000, the medical community severed ties with Live Donors upon their hospital discharge. Even now, transplant centers are only required to submit the most basic follow-up form for two years, and the examination is done by the Live Donor’s primary care physician and not the original surgeon or nephrologist.

Dr. Humar, like many transplant surgeons and Live Donor Proponents, is deliberately manipulating the truth, utilizing the lack of comprehensive data regarding Live Donors’ health and well-being as proof that physically and permanently compromising a person by removing an essential organ is ‘safe’. Absence of proof is not proof of absence.

Dr. Humar is also quoted as saying, “Surgeons…can limit [complications] by following regimented procedures, carefully screening patients and preparing for problems that occur.”

Except, they don’t. Instead of ‘regimenting’ procedures to minimize risk to Live Donors, transplant centers across the U.S. have been broadening their criteria to include people previously deemed unacceptable due to age or a health-related concern (hypertension, obesity, etc). Worse, they are given almost total discretion over their evaluation and care procedures, so there are no concrete standards, quality control, nor punitive measures to be taken for incompetency.

Informed Consent requires that prospective Live Donors be FULLY informed of the risks of live donation, yet they are regularly not told about the nearly 200 live kidney donors since 1993 that have needed their own transplant, nor are they informed of the risk of vascular injuries (renal artery, renal vein, aorta, common iliac artery, vena cava and mesenteric veins), bowel injuries, spleen laceration, liver laceration, pneumothorax, diaphragm injury, cardiac arrhythmias, urethral strictures, atrial fibrillation, small bowel obstruction requiring return to the OR, sepsis, respiratory distress, pneumonia, retroperitoneal hematomas, hernias, testicular swelling, adrenal gland dysfunction, nerve damage, hypertension, adrenal gland dysfunction, lymph leakage, and severely reduced kidney function.

It is also known that Live Donors suffer from depression, anxiety, anger and PTSD, yet transplant centers offer no mental health or supportive aftercare services. Even though a 1972 Medicare benefit exists to cover all Live Donor-related expenses, transplant centers and CMS violate the law by seeking reimbursement from the recipient’s insurance, resulting in the Live Donor paying out-of-pocket for any mental health services needed.

If Dr. Hamar and the transplant professionals at UPMC are such proponents for Live Donation, I suggest they begin by having themselves tested as prospective kidney and liver donors. Their first-hand knowledge of the Live Donor process will not only prove invaluable to their patients, and it will instill the public’s confidence. After all, there is no substitute for leading by example.

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