When I told my family that I was considering an undirected kidney donation – a donation where I did not know the recipient – they thought it was unnecessary and dangerous. They weren’t entirely wrong, but they weren’t entirely right. To use the most common of all skeptical refrains, “It’s actually more complicated than it seems.”
Not necessarily necessary.
There was nothing wrong with my right kidney. There is no strange disorder that made it preferable for me to reduce my kidney function. There’s no essential need that could only be satisfied by donating a kidney. When people said that my donation was unnecessary, they were right in that it was not a necessity for me.
However, there is another person in the equation: the recipient. A donated kidney was very much a necessity for them. Currently in the United States, there are over 100,000 people waiting on a kidney transplant. On average 13 people die per day while on the list waiting for a transplant and others become too sick to receive transplants. I worked with a woman a few years ago who suffered from chronic kidney disease (CKD). Because of her disease, she developed hypertension, had trouble concentrating, was continually tired, and suffered from muscle cramping. Most importantly to her and her family, the increased risk due to CKD meant that she was advised not to have children. For some people becoming a parent is a defining goal of their life. Being denied that goal can be painful and depressing.
Fortunately, the story of my friend has a happy ending. After several years, she was able to get a kidney transplant and went on to have a beautiful child. Her story is not unique. I have known a few other people who received organ transplants and have witnessed the dramatic improvement it makes in their quality of life. So, a kidney donation is necessary for some people. Some people need it to live. Other people need it to achieve their dreams.
But why did I need to be the one who donates? The answer is (of course) complicated. Most of us choose to be a part of a society. We could simply turn our backs and walk away to become hermits, but most of us choose to stay. One of the reasons, I believe, is that being part of a society carries an implicit guarantee that, when we are in need, the other members of our society will help us. It also obliges us to help other people. When someone falls, we help them up. When someone is in a car crash, we stop to render assistance. We do this because it is part of our social contract. I have accepted help throughout my life, and I am obligated to help others whether I know them or not.
In short, I felt it was necessary for me to donate a kidney because I believe that I entered into a social contract that requires me to help others if I can. And I could: I could help someone who needed a kidney.
Danger, Will Robinson!
Ok, so a kidney donation is a necessity, but what about the danger? You might be wondering, could I die, or could my quality of life be severely impeded? And what if I develop kidney disease or a family member needs a kidney donation later – am I harming myself or my family by giving my kidney to a stranger instead of saving it for them? These are rational questions. And, because they are rational, they have already been answered by the organisations that coordinate kidney donation.
Death. This is the big one. People die during surgery, and removing a kidney is a major surgery. The risk of dying during kidney surgery is 3 in 10,000. To put this in perspective, if you live in the United states, your lifetime risk of dying from choking on food is 1 in 2,535. I was absolutely increasing my risk of death by donating, not as much as I do when I eat something, but slightly more than I do when riding a bicycle. To offset that risk, the National Kidney Registry in the United States has the Donor Shield program which provides $500,000 (US) in life insurance for kidney donors. An insurance benefit won’t bring me back to life, but it does set the mind at ease regarding this real, but very small, risk.
What about the long-term health impacts? People have two kidneys for a reason. With only one, would I have to go on a special diet or avoid certain activities? The answer to these questions is no, not really. When one kidney is removed, the other kidney increases capacity to compensate. I won’t get back to 100% of the kidney function I had before the surgery, but I will probably end up with 70% to 80%. This means I need to eat a normal, healthy diet, but I don’t have to make any extreme changes. However, I do only have one kidney now, and need to be more cautious about injuring it. If I wanted to take up rugby, I should definitely wear padding over my left kidney.
But what about other health risks? Am I shortening my life? The answer, again, is no. My long-term survival rate is about the same as the general population, although there is one thing I need to watch out for. It looks like there is a low, but increased, risk of developing high blood pressure due to kidney donation. Researchers are trying to put a number to it, but it is difficult to compare kidney donors with an appropriate control group. Donors are healthier than the average population because they go through an intensive screening program, and people who have common health issues are screened out. My risk of developing hypertension has increased, so I need to make sure that I don’t take up any new habits that might increase that risk further.
Back to kidney disease. Does donation put me at a higher risk of my remaining, harder-working kidney, giving out at some point? Maybe. There are a small number of donors who develop kidney failure, and researchers are struggling to determine if the risk is greater than for the general population. To minimize this risk, my doctor advised me to wait to donate until I was about 50 years old. By this time, if I were going to develop kidney disease, it’s very likely that the pre-donation screenings would catch the indications. At this point in life, I have a very low risk of developing kidney disease. If it has increased slightly, I am still at low risk.
Still, what if I do need a kidney? Or someone in my family needs a kidney? Some smart people have already addressed this situation. There is a registry of people who need kidney donations, basically a waiting list of people who get matched when kidneys become available. As a donor, if I need a kidney in the future, I get priority on that list. It’s not as nice as having my right kidney, but it means that I will spend less time waiting and will be able to get a kidney sooner, should I need one. The National Kidney Registry makes a point that – out of 5000 kidney transplants, they have had zero donors who needed to take advantage of this benefit. Similarly, they have provided me with five vouchers for family members who may need a kidney donation in the future. The first person to activate the voucher (if any do) will be given priority placement on the waiting list.
I gave my right kidney to a complete stranger. I did it because I think that I am supposed to help people. It may have increased risk in my life, but the risk is small and can be mitigated to make it smaller. It was the right decision for me, and I hope that it might be the right decision for someone who reads this article. Your decision to donate a kidney could save someone’s life.
