Kidney donor's youth — age 2 — bothered 56-year-old recipient

[okarol]

Published: 12.30.2007

Kidney donor's youth — age 2 — bothered 56-year-old recipient

By Carla McClain
ARIZONA DAILY STAR

It gave this kindly man pause — that the two kidneys that could heal his body and give him a free and active life would come from such a young child.
But in yet another landmark organ transplant at University Medical Center, William Diehl — a Willcox grandfather — was given kidneys donated by a 2-year-old on the morning of Dec. 10.
"It kind of bothered me — that the organs had to come from a baby," he said. "I had to think about that."
But the fact is that when transplant surgeons finally figured out that they actually could use these very small organs to save adult lives, it has put a small dent in the horrific shortage of donor kidneys in this country.
Right now, more than 74,000 people are waiting for kidneys. But fewer than a quarter will get one in the coming year.
"These baby-to-adult transplants are not frequently done — usually at the major transplant centers," said Dr. Rainer Gruessner, UMC's new chief of surgery. Gruessner has brought cutting-edge experience as an abdominal transplant surgeon to an effort to rebuild the hospital's transplant program.
"But the issue is so many patients waiting on the kidney list," he continued. "Using these small donors for adults is one way to expand the kidney transplants we can do."
For a man of 56, a single kidney from a child so small would not do the job. So surgeons instead transplant the child's entire kidney block — the two kidneys connected by the major blood vessels — into the adult.
This is known as an "en-bloc" kidney transplant — a technically challenging and somewhat riskier surgery than the far more common transplant with a single adult donor kidney.
Only about 100 en-blocs are done per year in this country, using donors younger than 5. As the surgical techniques have improved — to deal with hooking very small organs and vessels up to an adult-size body — several studies have concluded that the operations are getting excellent results and should be done more often.
"In the current era of severe organ-donor shortage, use of en-bloc technique allows for valuable utilization of deceased donor kidneys that might otherwise be discarded," states an analysis of this transplant in a 2005 issue of the American Journal of Transplantation.
But chief among the en-bloc risks is a higher threat of a blood clot, which can be triggered by the child donor's very small blood vessels.
"That was the problem that caught my attention," said Diehl, who is doing so well post-transplant that he actually made a trip to Willcox this weekend.
Since the transplant, he no longer needs dialysis — that three-times-a-week grind of hooking yourself up to a machine for several hours to do the work of failed kidneys. It's a tedious procedure that leaves patients drained of energy.
Diehl had been on dialysis for a year and a half — ever since his kidneys failed due to polycystic kidney disease. He probably has had the disease all his life but was not diagnosed until he was nearly 40. He finally lost one kidney to the disease in May 2006, with the other all but dysfunctional.
Diehl, who has four grown daughters and seven grandchildren, is regaining strength and enjoying new freedom to be with his extended family.
"He's a basically healthy man in good shape, and we wanted to go ahead with this when the kidneys became available," Gruessner said.
"The whole aim of a kidney transplant is to get patients off dialysis, and we didn't want to wait," Gruessner said. "With the donor shortage, that wait could have lasted many more months."

DID YOU KNOW . . .
Organ transplants first geared up at University Medical Center in the late 1970s, with UMC's most successful program — heart transplants — opening in 1979. That program continues to perform heart, lung, heart-and-lung, and now heart-and-kidney transplants.
UMC's abdominal transplant program began with kidney transplants and has gone on to liver, pancreas and kidney-pancreas transplants. Plans are under way to begin intestinal transplants, as well as islet-cell transplants for diabetics.

TO BECOME AN ORGAN DONOR:
• Online: www.azdonorregistry.org
• By mail: Ask for a form by calling 1-800-943-6667.
● Contact reporter Carla McClain at 806-7754 or at cmcclain@azstarnet.com.

http://www.azstarnet.com/sn/news/218427.php

[Romona]

His transplant was like mine. I didn't realize that it was not done often.

[paris]

Romona, I wondered when you said you received two small kidneys. I imagine it doesn't happen very often.  That makes you very special----but we already knew that!

[George Jung]

I didn't realize that it was not done often.

That is kinda scary that they did not discuss ALL of the risks with you.  According to the article there are additional factors to consider compared to the more traditional procedure.

[Romona]

Everything happened very fast. When the coordinator called I thought she meant a 13 year old boy's kidneys. She explained it being a 13 month old. I had a UTI that I was half way through antibiotics so I thought it was not going to happen. She called the surgeon and he had her call back right way. He wanted me to come anyway. They kept explaining the match was so good. Both the donor and I had low antibodies. He felt that since I was a small woman (smaller than I am now) the kidneys would grow to fit my body. The risks of blood clots are there for any transplant. What concerned me was cause of death. I was told it was an immune disorder that did not affect his kidneys. I found out later that the cause of death was dehydration. I am in contact with the family. I keep tabs on my donor's twin brother who also has the disorder. I think that at the time I did what we are all told to do. Have faith and put it all in God's hands. I felt intense guilt for a long time. I had been praying for a miracle, I didn't want my son to be my donor. He had just been tested. I prayed I wouldn't pass my eval, I didn't want anyone I knew to donate to me. I never really thought about a deceased donor because the lists are so long. I had looked at UNOS stats. I felt it was the right thing to do. About a week after my transplant I found out my son was a perfect match. I still feel guilt at times that my prayers were answered that way. What is really strange is that the two weeks before this I found myself praying almost constantly and almost sub consciously. Anytime I was alone I was running prayers through my head. It never happened before and hasn't happened since. It was like I was preparing myself for something.

[paris]

The transplant team makes the best decision they can at the time.  There will always be more risks than we are aware of at the moment.  We need to go into all of this realizing that there are untold factors we will not know. 

Romona, you have an amazing story and thing seem to have worked out the way they should. I am glad you keep in touch with the donor's family. It must give them great comfort.

[Romona]

My donor family have given me comfort. They are so very supportive. At first our letters and cards were very formal. Now it is like writing an old friend. They call my coordinator if they don't hear from me. They worry about me, just like my family. I am so very blessed!