By Harrison Manacsa, Biological Sciences, ‘17

Author’s Note:

“This started as a case study I wrote on my friend’s chronic kidney disease for UWP104F. She was diagnosed during our freshman year; and I see the impact of her weekly dialysis on her family, diet, and college schedule. Knowing that a kidney transplant will greatly improve her health, I researched the processes one would undertake to donate their kidney. As it turns out, there are numerous factors one should consider. My article briefs on the current state of kidney donation. It is an expression of my amazement of turning our bodies into tools.”

We have two hands. We have two eyes and two ears. We have a pair of lungs and a pair of feet. Often, we overlook why some of our body parts come in pairs. Even more so if we’re left with one. If I were to lose one or both, could you share yours? Are our bodies purposefully designed with spare parts?

Sitting just below our stomach, sandwiching the left and right ends of our small intestine, are two fist-sized, bean-shaped organs that drain to one bladder. The kidneys are the filters of our body and the gateway to the urinary system. As harmful salts and metabolites in our blood sift through the filtering nephrons, they are pumped into the bladder and become urine. One kidney can accomplish this task. But two kidneys double the body’s filtering power, which underpins the congruency of all harmonious body pairings. However, when both kidneys are dysfunctional, blood filtration halts. Bile and ions recirculate in the blood and poison the organs from which they came. Urination ceases, and body-wide organ failure ensues.

As the modularity of the human body becomes more apparent to us, we realize that sharing our kidneys is just one of the many humanly attributable acts that we can do for one another. Since the early 1900’s, scientists have been fascinated with giving the organs of brain-dead, effectively deceased people to living patients. In 1954, Dr. Joseph Murray and Dr. David Hume perfected the first living donor kidney transplant between identical twin brothers. Eight years later, the medical pair performed the first deceased donor transplant in a procedure that demonstrated patient-donor kidney compatibility (Barker et al.). The two types of kidney donors offer their advantages and shortcomings. While deceased donors may give up both of their kidneys, living donors can only give one. However, living donors often present stronger, cleaner, and healthier kidneys that are less likely to fail in a recipient’s lifetime (“Living Kidney Donor Network”). Today, many patients in the United States receive new kidneys from deceased donors; however, these donations are currently managed by an overwhelmed and impacted system (Organ Donation and Transplantation Statistics).

In 1984, the United States Congress passed the National Organ Transplant Act (NOTA), which established the guidelines for the nationwide allocation of organs to transplant patients. Part of NOTA’s Title II proposal is the establishment of the United Network of Organ Sharing (UNOS) (Public Interest Law). Today, UNOS maintains the central database of eligible patients waiting for a cadaver’s kidney. But due to the increased demand for kidneys, UNOS has been stigmatized in pop culture as the ominous “waiting list.” Patients suffer interminable waiting times and dwindling patience. In 2014, the National Kidney Foundation estimated that of the 100,000 patients that waited in line through UNOS, only 11,570 underwent a transplant. On average, 3,000 new patients were added every month, while the median waiting time for a patient steadily increased to 3.6 years (Organ Donation and Transplantation Statistics). During this time, a patient’s immune system and vasculature will have deteriorated until he or she has become too weak to even undergo a transplant. For this reason, UNOS encourages healthy individuals to consider becoming living kidney donors. UNOS’ homepage greets visitors with an advertisement recruiting living-kidney donations and lists the basic criteria needed by eligible donors (Home | UNOS).

Ideal kidney donors must be at least 18 years of age and free of any health conditions that are difficult to treat, such as AIDS or cancer (Living Donation). Additional requirements vary by a donor’s specific body criteria—gender, body weight, usual diet—and the state where the surgery will take place. Once evaluated, a donor is matched to a kidney recipient with similar blood and immunological antibodies (Living Donation). Surprisingly, the strict need for perfect donor-recipient pairings has decreased in recent years. With the troubling health statistics of transplant patients, Dr. Karl Womer of Johns Hopkins Medicine believes that “it is really important to have a transplant as soon as possible and with any degree of matching. It’s better to have a transplant than not” (“What Kidney Donors Need to Know”). Donors typically undergo a laparoscopic nephrectomy. Once they are anesthetized, three small incisions are made at-and-around their belly button, where a camera and a hot cauterizing iron are inserted. Surgeons carefully burn all connections to the kidney, and then simply reach in with their hand to grab it. Larger donors may need to have a wider incision for better identification and acquisition of their kidney. After the two-hour surgery, donors recover in the hospital for an additional four to six days (Gupta et al.).

“Living donors recover quickly,” says Dr. Edward Gibney, a nephrologist at Piedmont Atlanta Hospital in Georgia (What It’s Like to Be a Living Kidney Donor). “[Donors] should be able to get back to work and [their] life in just a few weeks.” During this time, the size and filtration rate of the donor’s sole kidney will increase to compensate for the loss of the other kidney. And because the donor and recipient will leave with only one kidney each, both patients will forever need to minimize all dangers that can physically damage their kidney, including lower-back injuries, excessive sodium and alcohol consumption, or misuse of prescribed medication. Although considered very unlikely, complications such as hypertension may arise in both the donor and the recipient but are manageable through healthy diets and moderate exercise. According to the National Kidney Foundation, more than 80% of donors are satisfied with their decision (What to Expect After Donation).

Yet if living donors more effectively rescue transplant-awaiting patients, why are volunteers still limited? Sally Satel, in her New York Times article “Why People Don’t Donate Their Kidneys,” conveys that people only donate their organs in an “altruistic” context. For instance, families and friends of transplant patients are more willing to donate because of their adherent values of emotional or genetic bonds (Satel). When 47-year-old Karen Shatka was diagnosed with polycystic kidney disease—a genetic disorder that caused a fluid-filled cyst to destroy her kidneys (Polycystic Kidney Disease)—eleven of her family members volunteered to donate (Kidney Living Donor Transplant A Case Study). Ellen, Karen’s stepsister, was the closest match, and the two underwent surgery at the University of California, San Francisco, in 2012. Ellen says that she is “so blessed to be a living donor for Karen. [She’d] do anything for her” (Kidney Living Donor Transplant A Case Study). But many other diseased kidney patients are not so fortunate. In 2014, 20-year-old Tamara Nguyen was diagnosed with end-stage chronic kidney disease, which meant that numerous factors, such as diet and predisposed hypertension, prompted her kidneys to deteriorate. However, upon learning of her condition, Tamara’s parents and siblings all refused to donate. Tamara believes that, as a Vietnamese woman, her family’s cultural stigmas place her health at a low priority. Instead, Tamara depends on dialysis to filter her blood for two hours, twice a week. She believes that she is better off seeking help from a stranger. In 2016, Nguyen is still on the “waiting list.”

When it comes to donating to a stranger, though, Satel laments that some institutions “forbid donors [from receiving] anything of tangible value in return for their lifesaving deeds.” Due to potential complications with the donor’s and recipient’s health, some institutions won’t fund transplant operations and recovery costs. Additionally, it is illegal to sell or purchase organs. NOTA’s “Title III,” the “Prohibition of Organ Purchases,” states that “it shall be unlawful for any person to knowingly… transfer any human organ for valuable consideration for use in human transplantation if the transfer affects interstate commerce” (Public Interest Law). This is all to say that donors may find difficulty in being rewarded for their generous gift. In fact, donors are largely ignored after their transplant surgery. According to the Living Donation California website, transplant expenses for a kidney donor are covered by the donor’s health insurance; however, subsequent follow-up and check-up services are not, and neither are lost wages from time off work (Who Pays for Living Donation and Kidney Transplants). Essentially, neither the health care providers nor the government will compensate kidney donors.

All limitations considered, perhaps institutions and regulations also bolster the need for donors. If donors are paid for the value of their kidney, then transplantable kidneys will become a purchasable commodity, and a free market for organs will favor patients who can afford them and exclude patients who cannot. Through donors, all patients have an equal opportunity for regaining a normal life. Supporters of such philanthropic approaches include Dr. Paul Dooley and Dr. Jeremiah Lowney. In 2004, the medical pair co-founded the website MatchingDonors.com, where potential organ donors can make an online profile and match with a registered transplant patient. Dr. Dooley was motivated to start MatchingDonors after his father was denied placement onto the UNOS transplant list because, as Dr. Dooley’s website conveys, “the list was so long that by the time a kidney would become available Mr. Dooley’s father would not still be alive” (Organ Donor, Organ Transplant, Organ Donor Services). It is unsuccessful stories such as Dr. Dolley’s that prompted Jacob Halupka, a 38-year-old father of three, to donate to a stranger. In a 2007 interview with People Magazine, Halupka described making his profile on MatchingDonors as “a calling. It’s difficult to read these stories and not want to help” (Kidneys Online). In fact, more and more people like Jacob Halupka are searching for patients-in-need online. In 2011, East Haven, Connecticut mayor Aprile Capone Almon donated one of her kidneys to Carlos Sanchez, a transplant patient she found on Facebook. Mayor Almon responded to Sanchez’s Facebook post with the  message, “Carlos, I’ll get tested, I’ve got two, so what the hell? You can have one” (Facebook Helps Facilitate Organ Donation). Today, MatchingDonors has over 14,000 registered potential donors. Many of the website’s pairings continue to be publicized by CNN, The Huffington Post, and television shows like “Hot in Cleveland” (Organ Donor, Organ Transplant, Organ Donor Services).

Clearly, the public is starting to become aware of something marvelous. We know that pairings are a natural component of nature, but as we have learned from the symmetry that underlies our anatomy, we increasingly realize that humans are capable of helping one another on an astonishing level. The decision to donate a kidney comes with an enormous responsibility for both the donor and the recipient. Donors should take into consideration the long-term benefits and risks to their health and wellness. Yet it is amazing that such a decision can even be contemplated by any such organism. Perhaps our organ-sharing abilities are what truly separate humans from other creatures in nature.

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