
Living donors are vital part of kidney transplant programs
Transcript
Host Amber Smith: Upstate Medical University in Syracuse, New York, invites you to be The Informed Patient, with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith.
Host Amber Smith: Upstate Medical University had one of the highest rates of living donor kidney transplants in New York state in 2023, and many of those were "altruistic" donations, from people who just wanted to help someone.
We'll learn more about living donor kidney transplants from Dr. Reza Saidi. He's the director of the Upstate Transplant Center and chief of transplantation at Upstate University Hospital.
Welcome back to "The Informed Patient," Dr. Saidi.
Reza Saidi, MD: Thank you. Glad to be with you, Amber.
Host Amber Smith: It's exciting that your team did 94 kidney transplants in 2023, and 32 involved living donors.
How does that rate compare with other hospitals in New York?
Reza Saidi, MD: A couple years ago, we used to have one of the lowest rates of live donor kidney transplant in state of New York. But in the past, I would say, four, years, we've had a significant change in our direction of the program and our different campaigns around our city area.
And I'm very pleased to announce that now we have one of the highest rates of live donor kidney transplant. Not only in the state of New York, but in the country. There are about 20 kidney transplant programs in the state of New York, and among those, I think we came third after New York University and Columbia University, when you look at the percentage of kidney transplants that came from live donors, and around the country, actually, the number of live donor kidney transplants has gone down since COVID. It used to be around 30%-40%, and now it's down to 20%.
But in our program, 35% of all the kidney transplants were done from a live donor. And this is something that we put heavy emphasis on for the past couple years, and we try to grow more because this is one of the best options for our patients. And, usually, with this kind of transplant, the patients have the best outcome.
Host Amber Smith: So what steps have you taken to increase the living kidney donors?
Reza Saidi, MD: I think the main thing I want to point out is about awareness. We spend a lot of time to basically talk to our referring physicians first and make sure they understand it's the best option. And also we talk to our patients. Now, we have a special program to basically teach our patients how to go and approach somebody and how to find a living donor.
For example, our patients put their stories on their social media, they go to their churches, schools will talk about this. I think these are the steps that we put in to increase the number. The other thing we have done, we expedite the evaluation of these donors. Now, most donors, (in) a matter of couple days, they get all the evaluation, and they get the yes-or-no answer.
I think that's also significant for the donors to be motivated to donate their kidney.
Host Amber Smith: So social media and just getting out there and sharing your story, that's working, that's making people decide that they would be willing to do this.
Reza Saidi, MD: Yes. Last year, we also had a live donor appreciation luncheon. We had this again this year. A lot of donors came, and we shared their stories, and these were aired in our area, and people (were) hearing this message, and since then, we've seen a lot of people just calling our program. They want to donate their kidneys, even to an unknown individual. We call it altruistic donation.
Actually, last year about 30% of all the live donor kidney transplants were done from the altruistic donors. It's also very important that you get this message out there, that people, especially if people are healthy and have a healthy lifestyle, can have a healthy life with one kidney, and donating one kidney to a stranger or family member doesn't jeopardize their health and their life.
Host Amber Smith: Well, I want to talk to you more about what it means for the person who's willing to donate, but tell us again, why does it matter? Why is a living kidney transplant better than a transplant from a deceased donor?
Reza Saidi, MD: Because a living donor, we screen all these donors and make sure that they're healthy, they have a good kidney function.
But when somebody passes away, there's a reason that the patient passed away. Now, the average deceased donor age in this country is in mid-50s, and a lot of these donors have a lot of comorbidities (other medical problems), like high blood pressure, diabetes or obesity, and the quality of the kidney is not good.
But for living donors, we screen them, and we pick the best. That's why the outcome's always better. And again, living donors is like elective surgery, compared to deceased donors, which is kind of a semi-urgent operation. The time that kidney is out of body for a deceased donor usually is a matter of 15 to 20 hours, but for a living donor, because both donation and transplant surgery are done adjacent to each other, they call it ischemic time, meaning the time that kidney is out of body without any blood flow, is a matter of couple minutes. That's why this kidney works right away. There's less damage to the kidney, and that's why these patients have the best outcome after live donor kidney transplant.
Host Amber Smith: Well, let's talk about some of the questions people may have when they hear that someone they care about is looking for a kidney donor.
You said that people can live a healthy life with one kidney instead of the two that most people are born with. Beyond that, who makes a good kidney donor? What are you looking for?
Reza Saidi, MD: You know, let me tell you a little bit about the scope of this problem we have. One out of seven people in United States has kidney disease, and unfortunately, a majority of people progress to the point that there is no treatment option for them unless they stay on dialysis forever.
But dialysis has its own ups and down, and about 10% of people on dialysis will die, on an annual basis. That's why this is a huge problem, and there are close to a hundred thousand patients on the list waiting to see a kidney transplant. And each year about 5,000 people on the list will die because there is no suitable kidney.
On the other hand, somebody who's healthy, with a good kidney function, can donate their kidney safely. Now, this operation is done through a minimally invasive approach, without any big incision, and the recovery is quick. And we've been doing this for 60 years.
Data clearly show that with one kidney you can have a healthy life, and it doesn't jeopardize your health or your longevity.
Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith.
I'm talking with Dr. Reza Saidi. He's the director of the Upstate Transplant Center, and we're talking about living donor kidney transplants.
Now, are blood relatives necessarily the best donors?
Reza Saidi, MD: Not necessarily. In the past, we thought that if you have a blood relative, you're maybe genetically more close, so that patient and the outcome is better. But now, with new drugs that we have, people have showed that even comparing the live donor kidney transplant from relatives versus non-relatives, the outcome is about the same. It's not a huge difference.
That's why this matter of "the blood relatives are better outcomes," I think, is a myth. As long as the quality of the kidney is good, relative, non-relative, doesn't make a huge difference.
Host Amber Smith: Are there conditions that would disqualify someone right off the bat from donating?
Reza Saidi, MD: Yeah, absolutely. Actually, that's why we screen these donors, make sure they're in good health, they don't have, for example, kidney disease, or they have no other comorbidities, like significant cardiovascular disease or respiratory problems.
That's why the other outcome is the best, because we screen these donors and pick up the best. A donor has to go through extensive examination.
First of all, all these donors that contact us, we do a screening questionnaire on them and make sure there's no red flag. If there's no red flag, we get the labs on them, make sure they have adequate kidney function. Then we see them, evaluate them, do extensive testing on them, make sure they're in good health, and they can tolerate an operation, and then they proceed to donation.
But the other thing we did to our program, actually it has been very helpful. We basically jam all this, evaluation into one visit. When the patients call us, we do the questionnaire. If they pass the questionnaire, we do the testing, and then they come one day, see all the providers. And if everything's good, they get their CT scan to look at the anatomy of the kidney.
And then we have a meeting; the committee decides whether or not that donor is suitable. And for the past couple years, we've adjusted our processes, and now the evaluation time for donors, as I said, in our program is about nine days. Nine days, they get a yes or no answer.
Host Amber Smith: So I'm assuming a person needs to be at least 18 or an adult.
Reza Saidi, MD: Yes. Absolutely.
Host Amber Smith: Do they need to be living in Syracuse or Central New York?
Reza Saidi, MD: No. We have one person, his cousin came from California, and one of these altruistic donors that I mentioned came from Portugal, used to live in Syracuse, saw one of his friends on Facebook needs a transplant, and he came all the way from Portugal to donate. We had a ceremony a couple weeks ago, and that patient came and talked to a TV station here in town about her history and how she got the kidney from an altruistic donor that came all the way from Portugal.
Host Amber Smith: So 10 of your living donor transplants last year were from altruistic donors who just wanted to help someone. Some of them were strangers, they didn't know them from the past or anything. Can you tell us more about what motivates these people? Is it the same thing as someone who's willing to donate blood?
Reza Saidi, MD: Yeah, I think they're just (showing) good citizenship. They hear these stories, and obviously a lot of these donors are very highly motivated and well educated. They go read about it and find out, "Oh, this is not a dangerous thing to do." And they look to donate to complete strangers, to just be a good citizen.
Host Amber Smith: So if someone contacted you and said they wanted to donate their kidney to someone in need, would that kidney go to someone here in Syracuse or someone on the waiting list at Upstate?
Reza Saidi, MD: Yes, when they contact our program, we look at people on our list -- we have about 400 patients on the list -- and see who's the match for that kidney.
Host Amber Smith: That's what I was going to ask. How do you choose who gets it? You choose the best match?
Reza Saidi, MD: Yeah, we try to choose the best match and give it to somebody that we know that's going to get the most out of that kidney.
Host Amber Smith: Now, how much would the donor and the recipient find out about each other in the future? Might they go their separate ways and never know who the other was?
Or do they get to know each other afterward?
Reza Saidi, MD: That depends on the donor, basically, if he wants to meet his recipient or not. Yeah.
Some people have said that "I don't want to do this." And some people, after a couple months, said, "Yeah, I want to meet my donor."
This is something that we give the donor the option: "What do you want to do?" That live donor luncheon that I mentioned to you? One of these stranger-donor/recipient pairs actually met each each other, and there was a very touching story. Both, actually, were in tears, when they recognized each other, and it was a very touching story. I think these stories actually can also promote live donation, hopefully, in our area, because, as I said, there are 400 patients on our list, and, unfortunately, some of these patients might die because there is no suitable kidney donor.
There could be someone who's willing to donate their kidney to a person that they're friends with or a family member, but they're not a good match. Can you still make use of that kidney? Yes. There's also a national donor exchange program that if your donor is not a match, they can go on that pool and they can find a similar situation around the country, that somebody else has a donor that doesn't match, and they can exchange.
We have participated in this program for now, two years. And last year we had a case that one of our donors donated here, the kidney went to Cleveland, Ohio. And another donor who donated from Cleveland went to the Mayo Clinic in Rochester (Minnesota). Another one donated in Rochester went to South Carolina. We can create these chains and use the incompatible donors, called the National Kidney Registry, which is a pool around the country that, because, unfortunately, some of these donors might not especially be a blood type match. And with this program, we can transplant those patients in a relatively short period of time.
Host Amber Smith: So if someone wants to donate their kidney, can they choose who on the list that it goes to?
Reza Saidi, MD: Absolutely. They can have a choice who they want to donate to.
Host Amber Smith: By name, or by characteristic? Can they say, "I only want it to go to a woman or only to a man, or ...?"
Reza Saidi, MD: I never had a patient that they said, "I want to donate only to a woman or man." They can say a name if they're their friend or relatives, or if there's another match, they can go on this national exchange program that you mentioned.
Host Amber Smith: That's good to know. Now, let's talk about once someone is willing to donate their kidney, and they are a match, and you've decided this is going to work. What happens next?
Reza Saidi, MD: Yes, that's a very good question. When there's a match, then we try to coordinate with the patient and their donors, see what's the best time for them to have this live donor kidney transplant. And usually we do it the same day. Usually there are two ORs (operating rooms). Usually first, the donor's going to go to the OR, and when they make enough progress, we take the recipient to the OR, get the recipient ready, and as soon as the kidney comes out of that donor, we transplant that in the recipient.
And as I said, because the amount of time that the kidney's out of body is very short, this kidney works right away.
Usually a donor, as I said, has a minimally invasive surgery through small holes and stays in the hospital maybe one or two nights, maximum, then they go home. And the recipient is usually in the hospital for about two, three nights, and they go home.
But the full recovery from the donor who donates their kidney is about two, three weeks. And usually they go back to their work, and they basically have a healthy, normal life after that.
Host Amber Smith: Are there potential medical risks after you're a donor?
Reza Saidi, MD: Yes, like any kind of surgery, there's risk of infection, for example, or risk of developing hernia. But these risks, they're very small. The risk of death is still there, but it's extremely rare. Understand this is still a surgery, despite the fact that we're doing it through the minimal approach.
I would say, it's a surgery, and there are risks, but with experience and passing the learning curve, we have a very good outcome. We have no donor complications so far, except maybe minor complications, like a wound infection, stuff like that.
At our program, the past, I would say, four or five years that I've been here, we never have had a major complication.
Host Amber Smith: If someone who donated went on years later to develop some sort of a kidney problem, would their donor history impact their future care?
Reza Saidi, MD: Yes. This is a very rare incident but can happen.
For example, let's say somebody donated their kidney and gets in a car accident, and the kidney's destroyed, and now they have no kidney, and they need a kidney. The system, because they want to appreciate their heroic act, they get highest priority for these donors.
If something happens and they need a kidney transplant, they're going to get the first kidney available, basically.
But that's an extremely rare indication to have a kidney transplant. It's a safety net that the system put in place for live donors, that if, God forbid, this happened, they get highest priority to receive the next available kidney.
Host Amber Smith: Well, Dr. Saidi, thank you so much for this interview and congratulations on the living donor kidney transplant numbers.
Reza Saidi, MD: OK, thank you.
Host Amber Smith: My guest has been Dr. Reza Saidi. He's the director of the Upstate Transplant Center and chief of transplantation at Upstate.
"The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe.
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