Living Donor: Patient Story
On any given day, patients and donor candidates at the Montefiore Einstein Center for Transplantation see Living Donor Transplant Coordinator Patricia McDonough to discuss transplantation, review potential donors' medical testing, participate in education classes and ask questions. This is a typical day on the job for the wife and mother of three, but most donors don't know that Patricia is also a living donor.
"My brother Vincent had chronic renal failure in 1998 and it became apparent that he would need a transplant," she said. "I personally felt that the program at Montefiore was the best. So, I steered my then-39-year-old brother there."
As Patricia was the best potential donor, she went through the standard process of preparing to donate her kidney: the tests, the interview and even bringing her husband in to make sure he was comfortable with her decision.
"[What was] my initial reaction? I cried. I went through all the 'What ifs' and then came to the question, 'What about my brother?' I finally reached a point where I wasn't afraid any more; donors are always afraid at first, but with education and support, they can come to terms with it and say, 'I can do this.'
"We did the surgery January 13, 1999. Once I made the decision to do it with this team, I never felt afraid that I would die or have a complication. I never thought I would have a problem under the care of this team.
"Donating an organ was the most [empowering] experience of my life. Every time I think about it, I have a sense of 'Wow! I'm so glad I did that!' It's a life-defining moment. You try to be a person of virtue, but all of a sudden, you get to do one right thing. At the end of my days, it is something I will always feel good about. A person gets to be brave, loving and giving-all in one simple act. Looking at my brother, I could see he felt like a new person. In fact, he was up painting his house just weeks after the surgery!
"He said to me, 'I don't know how to thank you.' But the reality is, I got more out of it; he got a kidney, I got to participate in a miracle."
Patricia Answers Key Questions About the Transplant Experience
Q: How is the experience of living donation different at the Montefiore Einstein Center for Transplantation?
Pat: The experience at the Montefiore Einstein Center for Transplantation is family centered, a personalized approach to live donation. A multidisciplinary team focuses on the potential donor. Before candidates are screened to see if they match the recipient, they first meet the team to talk about the risks and benefits of donation, see a slide show and ask questions. The likelihood of matching the intended recipient is high if the blood type is compatible. However, the difficult part is the medical evaluation - the lab tests, EKG and CT scans. Donors see three different physicians to ensure that the donation will be safe.
Q: What are the risks with donating a kidney?
Pat: Donating a kidney, called donor nephrectomy, is performed by transplant surgeons with specialized skills in living donation, including minimally invasive surgery.
As with all surgery, complications can occur. All patients will have some pain, which is controlled with medication after the surgery. Some patients may also experience constipation, nausea and occasional fever. These symptoms resolve soon after the surgery. After discharge, patients are followed closely in the office.
Death from donor nephrectomy is extremely rare. The risk is estimated at 0.03%, or 3 out of every 10,000 surgeries. Our complication rate is very low; most complications are minor and easily treated. Complications may include infections such as urine or wound, hernia, bowel obstruction, bleeding, blood clots and damage to the donor kidney preventing transplantation. We turn down many donors for reasons such as high blood pressure in order to avoid lifelong health problems in the donor after kidney removal.
Living donors must be followed each year to ensure they are healthy. Montefiore follows living donors beyond the minimum two-year United Network for Organ Sharing (UNOS) requirement, and it is always there for living donors.
Q: Who can be a living donor?
Pat: Typically, live donors are family members or close friends, but any healthy, mature adult can be a living donor if he or she completes the evaluation and education and is able to understand the risks. Donors should be free of duress or coercion in making their decision.
Reasons for disqualification as a donor include:
- Age younger than 18 years
- History of blood clots
- History of coronary or other heart disease
- Untreated psychiatric disorders
- BMI (Body Mass Index) greater than 35; obese patients may see a nutritionist for weight loss counseling
- Significant chronic lung disease
- Recent malignancy, other than skin
- HIV infection
- Active Hepatitus B or C virus
- Kidney disease (creatinine clearance of less than 90cc or significant protein in the urine)
Q: What are the benefits of the recipient and donor?
Pat: Benefits to the recipient include:
- Live donor kidneys last longer than deceased donor kidneys.
- There is no waiting time with a live donor, so the recipient does not have to experience the effects of chronic dialysis.
- There is flexibility with scheduling the surgery.
The living donor also receives several benefits:
- Donors undergo a thorough medical check and do not incur costs for the tests, surgery and hospitalization.
- Donors receive an incredible emotional benefit and sense of pride from knowing they are helping someone in need. In response to questionnaires sent to donors, 97 percent of those who responded said they would do it again.