Live organ donation is safe, but not available in Quebec

Another gift of life to consider

Live organ donation is safe, but not available in Quebec

By EVRA TAYLOR LEVAND and EDDIE LANG, The Gazette June 15, 2010 2:03 AM

Providing a life-saving organ from the recently deceased to a critically ill patient is the way we normally think about organ donation -but it is not the only approach. This week, we look at the other "gift of life" which, through an incredible act of generosity, can transform someone with a life-threatening condition and vastly diminished quality of life to full or nearly full health. Donating your kidney is no small decision, but is it safe?

What do kidneys do for us?

The function of kidneys is to clean your blood of harmful wastes, extra salt and water, and to make hormones that keep your bones strong and your blood healthy.

When the kidney is functioning normally, all of these toxins and excess fluid are excreted in the urine.

Kidneys function less efficiently as we age and in certain diseases they can begin to operate at only a fraction of their normal capacity.

Diabetes and high blood pressure are the major causes of chronic kidney disease, although some auto-immune diseases can result in kidney failure.

What happens when the kidneys fail?

In kidney failure, these tasks must be performed via a treatment called dialysis to prevent the lethal build up of toxic metabolites in the blood.

In hemodialysis, the most common type of procedure, blood is withdrawn from the body by a machine and passed through an artificial kidney called a dialyzer.

Each hemodialysis treatment normally takes four to five hours, and is typically done three times a week, in a medical facility. The disadvantage of dialysis is its obvious negative impact on one's quality of life in terms of inconvenience, time spent, work interruption and the tremendous burden it places on one's ability to enjoy a normal daily routine. Kidney failure patients are often very weak and suffer from poor appetite, swelling and fatigue.

How prevalent is chronic kidney disease in Canada?

There are approximately 35,000 Canadians living with kidney disease and 3,000 people in this country are currently waiting for a kidney transplant with demand on the rise. Nearly 1,200 kidney transplants were performed in Canada in 2007, including 480 from live donors.

What is living kidney donation?

While most of us are familiar with the concept of organ donation from a deceased person, a healthy living person also can donate a kidney, known as living kidney donation.

Blood tests will determine if the donor and potential recipient are a match; if they are, they are known as a compatible pair.

Tell me about the Living Donor Paired Registry

Kidney donation is done on a voluntary basis and may extend to those beyond one's family, as a true act of altruism.

The Living Donor Paired Exchange Registry, initiated by Canadian Blood Services, is designed to facilitate kidney donations among live donors, matching them with those suffering from end stage kidney disease.

The Registry is a secure computer database that compares the medical information of prospective donors and recipients and identifies potential matches.

The benefit of such a coordinated effort is that it increases the chances of finding suitable matches, allowing people to receive kidneys faster, thus improving lives.

Canadian Blood Services forecasts that the Registry will increase live kidney donations in Canada by 20 per cent or more.

In the first year of operation, the Registry yielded 39 transplants in the three pilot provinces (British Columbia, Alberta and Ontario). These are people who might not otherwise have received kidneys were it not for interprovincial collaboration. As more provinces come on board, the Registry's potential will be unleashed.

The Registry operates in several Canadian provinces, but not yet in Quebec.

The study

Segev DL, Muzaale AD, Caffo BS et al. Perioperative mortality and long-term survival following live kidney donation. JAMA 2010 Mar 10;303(10):959-66.

What was this study trying to show?

Despite the great numbers of people who have donated their kidneys to improve or save the life of someone in need, there is only limited earlier research on whether or not this act of kindness can affect the donor's health.

This study looked at more than 80,000 live kidney donors in the U.S. who had their organs harvested during a 15-year window from 1994 to 2009.

The researchers were particularly interested in looking at whether or not donors live as long as the general population, and if they themselves are at risk of developing kidney disease by virtue of having one of a pair removed. They compared mortality in these donors with a smaller group of individuals with similar health characteristics.

So is kidney donation safe?

The risk of death from the surgery itself is tiny but not negligible, and based on these U.S. figures, falls in the range of one in 3,300 donors. The researchers noted that donors with high blood pressure, as well as males and those of black or Hispanic origin were at increased risk of dying of complications.

Importantly, however, for the duration of followup that this project measured, donors were not more likely to succumb to an early death than their non-donor counterparts.

We know, though, that donors must undergo intensive screening as well as physical and emotional assessments before being allowed to undergo kidney removal.

So despite best efforts through statistical adjustments to make the groups seem equal except for the donation surgery, there may have been some degree of long-term risk that was masked by the subjects' generally healthy pre-operative condition.

What is the take-home message?

Kidney failure is a devastating illness, and we now have skilled transplant teams that can cure these patients with a combination of surgery and anti-rejection drugs.

We can only hope for consideration of a live donor program in this province as a means of rescuing the many sufferers from their next encounter with a dialysis machine.

The material provided in HealthWatch is designed for general educational purposes only and does not pertain to individual cases. It should not replace necessary medical consultations with your own doctor or medical professional.

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