By Bednar, Joseph
Edward Reilly needed a new kidney. His wife, Karen, volunteered to be his donor, but she wasn’t a match.
Meanwhile, Calvin Denson also awaited a kidney donation. After a year of submitting to dialysis three times a week, he felt close to giving up hope.
Then Karen Reilly learned about the New England Program for Kidney Exchange, which helps people whose living donors aren’t compatible matches. The program uses a computer program to find cases where the donor in an incompatible pair can be matched to a recipient in another pair. By exchanging donors, a compatible match for both recipients may be found.
So she decided to enroll, knowing her willingness to donate would boost her husband’s chances as well. As it turned out, she was a match for Denson. Meanwhile, a woman named Lydia Carollo, who had decided to become a living kidney donor after reading a flyer about someone in need, was eventually matched with Edward Reilly.
“I still wonder why she did this wonderful act, and I will always cherish this selfless act of kindness,” Reilly said. Carollo said simply, “I did this to help someone live a longer and healthier life.”
Meanwhile, “I wanted to give up on life,” said Denson, “but when the transplant office called me, I got a second chance. A person, an angel, who didn’t know me was going to do something so selfless.”
These interlocking stories had happy endings, but tens of thousands of people across the country are still waiting anxiously to see how their stories will unfold – because demand for organs far outstrips the number of donors.
In fact, about 77,000 people are on the waiting list for kidneys nationally, with another 10,000 to 20,000 adding their names each year. The waiting list in Massachusetts is about 1,500 at any given time, a number that’s also rising.
“Donations have actually been stable or slightly increasing, but the number of people coming on the list is so much greater than it was,” said George Lipkowitz, director of Transplantation at Baystate Medical Center, the region’s only transplant hospital.
Even with a dramatic uptick in donations, the situation would be dire, he noted. For example, if someone dies in an accident or otherwise suddenly but has not expressed any intent to donate organs, family members are asked for consent. “The consent rate has actually risen over the past five years or so, and we’re in the neighborhood of 55% to 60%,” Lipkowitz explained. “But even if everyone consented, we’d still have a donor shortage. It’s just a losing proposition.”
Part of the problem is actually a real positive for society in general: a marked decrease in road fatalities due in part to cars designed with a broader focus on safety. In addition, he noted, “many traumatic injuries, such as gunshots and stabbings, are related to drugs, so those individuals are not good donors.”
For a variety of reasons, “there just aren’t enough organs from deceased donors,” he told BusinessWest, “so we’ve relied more and more on live donations over the past 10 to 15 years” – people like Reilly and Carollo, who simply want to make a difference.
Parting Gifts
Massachusetts now has a law on the books requiring anyone getting or renewing a driver’s license to be offered the option of organ donation, and those willing will have the preference printed on their license, so a kidney or other organ may be salvaged quickly in case of sudden death.
“At least that makes everyone think of it,” Lipkowitz said. “A lot of times, someone would be willing to donate, but the family doesn’t know that. This way, they have documentation, and everyone knows what your wishes are.”
Still, kidney donations by living donors have many advantages over postmortem, or cadaveric, transplants, including better genetic matches and less risk for rejection – not to mention that surgeries can be scheduled at the convenience of the donor and recipient.
Fortunately, attitudes toward organ donation have changed for the better, said Lipkowitz. In years past, living donations were typically made only between relatives; then, as demand rose and people became more comfortable with organ donation, there was a rise in donations from non-relatives – spouses, friends, and others known well by the recipient.
“Now, it has become acceptable to have anonymous donors, people who just want to do some good by donating a kidney to someone they don’t know,” he said. “It’s not very common, but they’re becoming more common, and we’ve done several.”
Anonymous donors are a special case, and all such volunteers are given a psychological workup to clarify their intentions. Some are turned down, “but there are some truly good people in the world who just want to do help someone else,” Lipkowitz said.
In all, Baystate typically performs between 30 and 50 organ transplants per year, with a recent high of 57. That leaves the region with a lengthy waiting list for kidneys. Some people never make it to the list because a living donor is immediately found among their family members, but others, like Denson, wait a long time – and wonder.
“We transplant kidneys, liver, pancreas, intestines, heart, lungs … kidneys are the most frequent, because, obviously, we can keep people alive with dialysis,” Lipkowitz said. “With a liver or heart, if someone doesn’t get an organ, they die. That’s why the kidney list becomes so long.”
Baystate has made efforts to create public awareness of the need for living kidney donations, which account for virtually all such transplants because of the body’s ability to survive minus one of them – as opposed to, say, a heart or liver. And that provides a teaching opportunity for this teaching hospital.
“With living donations, we have a long time to talk to people” about their anxieties, expectations, and often misconceptions about giving up a kidney, said Lipkowitz. “Some people worry about pain afterward or think it shortens their life, but it doesn’t. There is some risk, just like anything in life; no surgery is completely safe. But it makes no difference in quality of life. We do these procedures laparoscopically, and the patient is usually back to work in a couple of weeks. The amount of pain compared to the old way of doing the surgery is much less.
“When we talk to people,” he continued, “when we describe things to them and are honest with them, we can usually allay their fears about donating.”
Tell the Story
Stories like those of Reilly and Denson demonstrate selfless acts of kindness and overwhelming gratitude, but also involve intricately planned surgeries and follow-up care, said Joan O’Shaughnessy, director of Renal & Transplant Services at Baystate.
“We have been making more efforts at publicity for cadaveric and living donations, and we’re part of the National Collaborative for Organ Donation, which is one of the attempts nationally to increase organ donations.”
Those efforts have managed to get more organ donors to commit on their driver’s licenses, pushed family consent rates higher, and made it mandatory for hospitals to report all imminent deaths before the fact, creating fast-moving lines of communication between hospitals, organ banks, and those waiting for transplants.
“We can rule out some people as donors, but we’d rather know everything in advance and send someone to talk to family members,” said Lipkowitz. “If families are approached by personnel trained in these issues, consent rates are much higher than when approached by just anyone.”
Copyright BusinessWest Jul 7, 2008
(c) 2008 BusinessWest. Provided by ProQuest Information and Learning. All rights Reserved.
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