Great Need: Advances have created larger field of donors

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Great Need: Advances have created larger field of donors

By Kim Underwood
WALL STREET JOURNAL REPORTER

Published: April 22, 2008

Although living donors increase the potential number of kidney transplants, many people are still awaiting a transplant.

According to the National Kidney Foundation, 17,092 kidney transplants were performed in the United States in 2006 -- about 6,400 of those from living donors -- leaving more than 70,000 still waiting. In 2006, 3,916 people died while waiting for a kidney transplant.

"There are too many people waiting," said Dr. Jeff Rogers, a transplant surgeon at Wake Forest University Baptist Medical Center.

Twenty years or so ago, a donor generally had to be a sibling, because the kidney had to be a close match for the transplant to be successful.

Major strides in recent years, particularly in the medications used to keep the body from rejecting the donated kidney, have enabled spouses, clergymen, co-workers, friends and others to become potential donors.

Even with more potential donors, more people are waiting for a kidney, in part because advances have also made successful transplants possible for people in poorer health as well as for younger and older people.

"We can transplant some people into their 80s, and they do quite well," Rogers said.

Some people are under the impression that dialysis is a viable alternative to a transplant, he said. That is not necessarily so.

"People die on dialysis," he said.

And in any case, receiving a kidney can significantly improve the quality of the recipient's life, he said.

Understandably, some potential donors wonder about the amount of pain associated with the surgery.

"Everybody is afraid of pain," Rogers said.

Advances in laparoscopic surgery -- also called minimally invasive surgery -- have made that less of an issue.

"The advent of that procedure has removed a lot of that disincentive," Rogers said.

Tim Shain, who recently donated a kidney, said he was uncomfortable for a few days but had no significant pain.

People also worry about needing the kidney themselves or for a loved one later. Most diseases that affect the kidneys affect both of them so it's not as if one kidney is waiting in reserve. Plus, if someone who has donated a kidney needs one, he is automatically put at the top of the transplant lists.

The surgery taking a kidney from a living donor is unusual in one respect.

"You are putting a healthy human being at risk," said Sharon G. Alcorn, the living-donor coordinator for the medical center.

"They take on all the risks with no physical benefits," Rogers said.

But the risks are relatively small, in part because only people in good health are approved as donors.

"It's a safe thing to do as long as they make it through evaluation," Rogers said.

Kidneys from living donors tend to work better and to last longer than those from people who have died. In part, that's because the donor is someone in good health. Also, with most living donations, the kidney is taken directly from the donor's body and immediately placed in the recipient in a nearby operating room.

Not everyone can donate a kidney. Obesity, diabetes, high blood pressure or kidney stones can make the person unsuitable as a donor. In general, younger is better than older but there is no official cutoff age, Rogers said. In a recent case, a 65-year-old man donated a kidney to his 68-year-old brother.

In determining matches for paired donations, a committee also looks at such factors as the relative ages and health of the potential donors to determine whether the "trade" is an equitable one.

Depending on the policies of the business a person works for, he might have to take vacation to make the donation. But the costs of the surgery and follow-up treatment are paid for by the transplant program.

The willingness of people to participate in paired donations greatly expands the possibilities, he said. More than one-third of the people who offer to donate a kidney to someone turn out to be incompatible. Now, if a paired donation can be arranged, they can still donate.

"Everybody gets what they need," Rogers said.

■ Kim Underwood can be reached at 727-7389 or at kunderwood@wsjournal.com

■ More information is available at such Web sites as www.kidney.org and www.transplantliving.com

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