Kidney Transplant


Should the US government reforms its laws to allow more kidney transplants?

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The waiting list for a kidney transplant is anywhere from 2 to 4 years depending on where you live, your blood type and other factors like compatibility and your size.  The list has about 80,000 names on it, and 11 of them die waiting, daily, which represents around 4,000 lives per year that are not saved.

I found an interesting article in a magazine called The Atlantic.  Its author, Conor Friedersdorf, suggests that the federal government should reform its laws regarding organ donations based on the fact that more and more Americans are going abroad to find a kidney.  One of the popular destinations is Peru.  Of course, this is a poor country and who really knows about the quality of the healthcare system.  People in those countries are willing to give one of their kidneys in exchange for some money so they have a chance to live a decent life.  There are risks to both the recipient and donor when these surgeries are performed in third world countries.  Who knows if they really do a good job in looking for compatibility and transmissible disease the donor might have.

Some people are willing to take the risk just because they are tired of living on dialysis (the alternative to kidney transplant).  Dialysis has its own risks: catheter and blood infection can all lead to death.  Who wants to spend half of his life in a dialysis center anyway?

Like I mentioned earlier, it takes years to get a kidney transplant for most of the people waiting on the list unless they can find a living donor.  Under US laws, it is illegal to pay someone for an organ or receive money from organ donation.  If transplant centers were allowed to give good money, like $30,000 or more per kidney, to the donor, I do think there would be a lot of people willing to give organs.  That could be a way to trim the waiting list pretty quickly.

I am afraid that if this whole process is not done the right way it could lead to some ethical and social problems.  One of those is would rich be allowed to bypass poor patients by offering extra incentives?  Should only hospitals be allowed to give money to the donors?  Would the donor and recipient be paired on a first come first serve basis or the recipient will be able to handpick his kidney?  Would there be good or bad reasons to accept a living donor candidate based on the motive?

Those all are questions that a panel would have to answer before moving forward.  I don’t think the living donor transplant centers are immediately ready to handle the surplus of work.  In a matter of a few months, one could see an increased of several thousand potential donors per hospital.  You need staff and infrastructure to process and screen all those kidney donors efficiently and safely.  A well-known hospital in the state of Pennsylvania temporarily shut down his living donor program last week because a kidney transplant recipient contracted hepatitis C with the new organ.

Even if the government allows people to get money for their organ, which I would not have a problem with, it will take several months or years to catch up to the list of 80,000 people waiting for a new kidney.  You just can’t safely screen and do surgery on that many people overnight.



Grandpa Could Become a Living Kidney Donor

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It is now proven that people over the age of 70 years old can safely become a living organ donor for kidney transplant.  A study that will come out in the Clinical Journal of the American Society Nephrology is showing there is no more risk for elderly to become organ donor than younger donors.  The investigators have studied more than 200 living kidney donor over the age of 70 and compared them with healthy people of the same age.  The outcome was quite surprising: the organ donors were living longer in general than the non-donor group.

Young Living Donor still Better

The only setback with older donor is that the kidney does not last as long as for younger living donor.  This is still a better option than the alternative for those patients who have received the gift of life.  If it was not for the elderly donor, they may have needed to be on dialysis for many more years.  The average wait time for deceased donor is in excess of 5 years in certain region of the US.

Many physicians are not aware that older people can become living organ donor and certainly not all transplant centers are willing to take a chance on an older patient.  Some claims the risk of complications is too high but you have to look at this: several thousand patients in their 70’s survive heart surgery every year in the US.  The operation for giving a kidney is much less traumatic.  There is still a lot of work to do to explore this group of potential donor, they only represent 1.5% of all living donor.  In numbers that means 89 donors only out of about 6000 kidney donors.

80 the new 70?

It is all about doing better education of not only the population but also for the healthcare professionals to promote what can be done safely as far as organ transplant go.  Every year limits of what was thought to be reached are pushed in the organ transplant world with the only goal of saving lives.  With the population living longer and healthier, will 80 become the new 70?

Renal Transplant and Pregnancy Can go Along Successfully (Maybe)

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It is not recommended for a renal transplant patient to become pregnant after transplantation but it can be done successfully as long as the future mom is aware of the risks.  According to a study published in the American Journal of Transplantation, pregnancy after kidney transplant is associated to higher live birth rate, lower miscarriage but more complications than the general US population.  I would have never thought that kidney transplant patient could have babies with relatively good outcome.

Dark Side of the Story

Despite having relatively good outcome with pregnancy, renal transplant patients should discuss the risks with their nephrologists.  It is not all kidney transplant physician who will support their patients idea to have a baby.   They also need to find an OB/GYN willing to take high-risk pregnancy patients because the follow up will need to be tight.  Despite having more babies delivered by percentage than the general population, the complication rate is much higher.  These complications need to be addressed before the pregnancy to improve outcome.

Preeclampsia Risk

There is 6 times more chance for preeclampsia (high blood pressure and protein in urine) in women with history of kidney transplant.  Some of the risk factors of preeclampsia that are related to a post renal transplant patient are kidney disease and vitamin D deficiency.  This condition can lead to eclampsia if left untreated and can be fatal for both mom and baby.

Gestational Diabetes

Another complication that is not as bad but still need to be considered is gestational diabetes.  The chance of having this complication is double the rate of a pregnant woman with no history of renal transplant.  Because most transplant patients take prednisone as immune suppressant, diabetes rate is higher to begin with.  Like all transplant patients know, prednisone is well known to increase blood sugar level.  The complications for this kind of diabetes (it mostly affects baby)are: excessive birth weight, jaundice, respiratory distress, higher risk of diabetes type 2 later in life.


More than half of the renal transplant patients having babies have them through a C-section versus one third of all pregnant women.  Any surgery after organ transplant has more risk than for anybody else.  C-section brings its share of complications such as infection, blood clot in legs, bleeding.  If a transplant patient is taking rapamune, it will have to be stopped ahead of time because that drugs delay wound healing.  Anytime there is a change in a successful immune suppression regimen there are risks for rejections. The decision on how to have the baby should be discussed with the physicians ahead of time so the risks and benefits are well understood.

Pregnancy after organ transplantation should always be discussed with your transplant physician before the baby is conceived.  Having a baby is a lifelong commitment and that should always be kept in mind.