Living Kidney Donation and Kidney Transplantation: Expert Q&A

April is Donate Life Month and there are currently over 100,000 people in the US awaiting a kidney transplant. A donated kidney can make all the difference in the life of someone with kidney failure. Our experts will talk about the process and benefits of living kidney donation and we'll answer your questions. That's coming up right now on At the Forefront Live.

And we want to remind our viewers that today's program is not designed to take the place of a visit with your physician. Let's start off with having each one of our experts identify themselves and introduce themselves to the audience and tell us a little bit about what you do here at UChicago Medicine. And Dr. Barth, you're actually on set with me, so we'll start with you.

Hi I'm Dr. Rolf Barth, I'm a transplant surgeon here. I'm the associate director of the Transplant Institute at UChicago. I do the operations of kidney, pancreas, and liver transplants, as well as the donor operations to take out the organs from our healthy donors.

We have some interesting information there to share in the program about a new procedure here anyway that you perform, which will be pretty I think fascinating to our viewers here in a moment. Now, let's get to our other two guests who are joining us from remote locations as we continue to social distance to the best of our ability. And Dr. Kyeso, you're actually the closest to us so we're going to start with you.

Thanks for having me. I'm Yousuf Kyeso, an assistant professor of Medicine at the University of Chicago. Am also a transplant nephrologist. Most of my work as a clinical, focusing on evaluating kidney transplant recipient's, kidney donors, and patient with multi-organ transplants. I also do clinical research with interest in studying a novel blood test that detects kidney rejection.

Great, and Dr. Krishnamoorthy or Dr. Sam, as a lot of people call you.

Thank you so much, Tim. My name's Dr. Sam and I'm also a transplant nephrologist working with Dr. Kyeso and Dr. Barth here at University of Chicago. I also do evaluations of dialysis patients and kidney disease patients to see if they're eligible for a kidney transplant, kidney donor evaluations, and I take care of transplant patients after their transplant.

Fantastic, let's jump right into the questions. We do want to remind our viewers though, that if you do have a question for one of our experts, just type them in the comments section. We'll get to as many as possible over the next half hour. And Dr. Kyeso we're going to start with you. And just have you tell us-- start off in a broad term here-- why would someone need to undergo an organ transplant if they need a new kidney? How does that work?

So first I want to start talking about a little bit the main functions of the kidney. The kidney has really three main functions and one would be eliminating the extra fluids in the body, second cleaning and clearing the blood from the toxins, and it also produces hormones to regulate our blood pressure and produce red blood cells from the bone marrow.

Now, patients with advanced kidney failure, especially when the kidney decline below 20%, they start having symptoms of that, which includes fluid accumulation in their body, sometimes they may start having nausea, vomiting, they lose their appetite, and they become severely anaemic. So the treatment with that would be either kidney transplantation, which is the best modality and sometimes we can also do dialysis as a bridge.

The benefit of kidney transplant for example, compared to dialysis would be they don't have to go three or four hours several times a week to be on the dialysis machine and that will give them a lot of free time to go back to work and function normally. Also, once they receive the kidney transplants, their body will get rid of all the extra toxins and patients feel it. Their appetite will improve, their energy gets better, and they start tasting food. Some patient actually tell me that even their skin color gets better. Also, studies have shown that patients who receive kidney transplants live longer compared to staying to dialysis. So I advise every patient with advanced kidney disease to come forward for evaluation and hopefully we'll get them transplanted. So Dr. Kyeso, do people have to wait a long time for kidney transplants? Is that one of the organ transplants where people are on the list for-- because you hear the stories that they're on the list for months or possibly even years.

Right. This is an excellent question. So it depends actually on several factors. So in the case of living donor kidney transplant, this process can actually happen within a short period of time once the recipient and the donor are ready for the surgery and it can take sometimes maybe several weeks to a few months.

Now, in the case of deceased donor kidney transplants, the waiting time depends on a couple of factors. One is the blood type of the recipient. Patient with the blood type for example, A or AB tend to wait a little bit less just because of their blood type characteristic. I would say maybe on average around three years of plus minus. Patient with a blood type O for example, OB tend to wait a little bit longer and this can be up to five to seven years. The good thing's that, once a patient starts on dialysis, the clock starts from day one of dialysis. So if someone comes in to me for evaluation, I start their time from day one of dialysis. Because once we list them, we count all of that time.

There are special cases for example, patients who received more than one organ like in the case of liver-kidney transplants or heart-kidney transplants. These patients require an urgent intervention, an urgent transplant. So this actually can happen within a very short period of time, could be a few days in certain cases when they come in very sick to the hospital.

So I'm kind of curious when we talk about multi-organ transplants and any one of you doctors can take this. Is it more common when you see, if one organ fails, that multiple organs then start having issues? Do you see that a lot?

So really the way I present it to patients, the kidneys are very interesting organs that talk to other organs. So the heart is not doing well, it's very likely that the kidneys will fail. Same thing goes with the liver and the kidney. If the liver is not doing well, it's very common to see advanced kidney failure. So we often see that when patients come into the hospital with advanced liver or heart disease, they require a liver or heart transplant. So actually we do evaluate them to see whether they need a kidney transplant along with a heart transplant or along with liver transplant.

At the University of Chicago actually we've done several triple organ transplant probably more than anywhere else in the world. We've done liver, heart, and kidney transplant at the same time.

Yeah, that's very interesting information. Dr. Sam how long is kidney disease manageable?

So I would start the answer by saying, it really depends. There are so many different causes of kidney disease. Some of which we have treatment options that can keep the kidney function going for as long as it can. Like Dr. Kyeso was saying, the kidneys not only clean the blood from toxins and take care of your fluid balance, but at the same time they also produce hormones.

We look at a number called GFR or roughly we equate it to us like a percent of how much your kidneys are functioning, and normal kidney diseases affect both kidneys. So when a patient's kidney function reaches about 20% to 30%, that's when we start seeing the effects and the patients also start seeing symptoms from these lack of hormones that they might start becoming anaemic. They might start having difficulty in producing vitamin D in their body and these can start having long-term deleterious effects from this point onwards.

Just like how the clock for being on transplant starts when you're on dialysis, you could get listed even earlier for a transplant when your kidney function reaches that GFR of about 20 to 25 and the clock can start ticking sooner in that case. And a lot of times the decision to start dialysis is made on different factors, including your lab numbers and how you are feeling and how much fluid you have on board as a patient.

And so it's manageable to a different degree for different patients depending on their age, what other diseases they have, like liver disease and heart disease that Dr. Kyeso briefly mentioned about and what their reserve is otherwise for their kidney function. So on a case by case basis, it definitely differs as to how long we can medically manage it, which is why we really encourage our patients depending on the speed at which they are losing their kidney function to start thinking about transplant when they reach that GFR of about 20 to 30.

Interesting. So I do want to remind our viewers that we will take your questions, just type them in the comments section and we'll ask our experts here to answer those questions. Dr. Barth, let's move to you for a moment and talk to us a little bit about kidney donations specifically from living donors. And why is that ideal?

Well, it's a great month to talk about it because it is our donate life month and really-- I think at the point where Dr. Sam or Dr. Kyeso have patients that they recognize are going to need a transplant, they introduce a donor transplant evaluation. They'll meet with a surgeon and the nephrologist that they've probably dealt with before and a full multidisciplinary team of nurses and other providers.

The thing I tell them first is that the most important thing they can do to take control of their future is to try to identify a living donor. And living donors is really just such a remarkable difference in the ability to potentially avoid dialysis and never even need to go onto a machine that requires daily treatments throughout their life, and get them the maximum survival benefit of an organ transplant. So we start these conversations of who in your life may be interested in donating? And then share with them what we can do with both their disease as a potential recipient and then how the donor processes work as well.

Perfect segue for a video that we have. Thank you for that because this is really helpful and John if we can go ahead and play this. This is a video dealing with both a donor recipient and we also have the donor in the video. Let's play that and then we'll talk about that coming up.

We're both back running. We both feel really good. You really tell these things. My time's got a lot slower. That's one of the first symptoms that showed up. I have polycystic kidney disease. And it's a hereditary disease and cysts grow on your kidneys and eventually choke out the actual real function of the kidneys.

It's just an amazing sacrifice. It's humbling to see him to be willing to do this. And just a great friend-- it's just amazing.

He's a really great guy and like I said he never put any kind of pressure on you. And he's like never complained and so yeah he's a really good guy. So my kidney found a nice home.

Rich not only participated by taking care of himself in terms of eating healthy and keeping his weight at a healthy state and staying active, he also participated in our Living Donor Champion Program. That is a program that is unique to the University of Chicago and what we do, r-- is we teach the recipients how to tell their story and how to go about asking others to potentially donate an organ. That's a very difficult thing. You're not asking somebody to loan you a cup sugar, you're asking somebody to go through a surgical procedure.

The surgery went very well. Successful, we're both back running. We both feel really good and we're both really happy about everything that transpired at the University of Chicago.

This is really one of the truly altruistic things that is done. It's a gift. It's the gift of life and it is the ultimate altruistic gift.

I love that story for so many different reasons. And I do want to give credit because John who's our technical director-- John Decco who sits back in the booth, is our technical director and director of the show. He also actually did the videography on that piece too. And those cool shots of them jogging, John did that as well. So neat stuff.

But a couple of points from that video. I love the two kidneys are for sissies t-shirts. That is neat. But just the comments that they made and just that this is a tremendous gift that you can give to another human being, which I don't think that can be overstated. It's just such a selfless thing to do. And you saw how-- and this is the other thing about that video that I think is so powerful. The donor and the recipient were back running in just a matter of weeks. So the recovery from this is pretty impressive.

It really is such a great story and typifies so many of the elements of why living donation is preferable outside of just the medical and the scientific outcomes, which we know are far more superior. I think that one of the things that we really do focus on is the donor operation and making sure that these donors now through the least invasive ways of possible of having surgery can get back to full speed and do these wonderful things.

I think what you sense from that video is really how joyful kidney transplantation is. Not many people would be excited if a doctor said you need to have surgery. But in transplantation we deal in this very special field where it really is an amazing experience and especially when there's a living donor and the recipient there. We really have a surgery that people are so happy about, it's a special event.

As the donor mentioned, his kidney found a good new home. So that was nice. So we do have some questions from viewers coming in. And this one actually tees up perfectly with what we just saw. What is recovery like for living donors? And Dr. Barth if you can help us out with that.

So we recently introduced a new technique to University of Chicago for donation. For a decade, almost two decades we've been doing minimally invasive surgery, but now we've kind of introduced what we really define as the least invasive technique offered anywhere which really through an incision, it's only just longer than an inch through the belly button, can do the entire operation. The donors literally go to the recovery and wake up with a Band-Aid or actually it's half a Band-Aid over their belly button and then about half of them will go home the next day.

So really we're talking about a major operation, but we're doing it through these really advanced minimally invasive ways. People are home in short order and then back to work. I still encourage the patients to really take care of themselves, give themselves a break for doing such a wonderful thing. These great people sometimes are so motivated they want to just get back to life as usual the next day but give their bodies a little time for recovery and generally, within a couple of weeks they're doing everything that they used to be doing.

If I remember correctly when we interviewed those two fellows for the runner story, I think they didn't 100% adhere to their doctor's advice as far as taking it easy for a while. They were anxious to get that going. But the wonderful thing is they felt so good, that they could.

Yeah, I think that that's one of the things that's amazing. It's the recipients who are suffering the consequences of renal disease and feeling ill immediately with a transplant. Notice just all these changes in their body and their life and just feel the best they've ever felt and you could really see that between the two of them.

So I wonder if you could walk us through how the process works just from a surgical standpoint because I know you work on both sides actually. So if somebody is working with their friend, they're living donor, whomever that's giving them a kidney, do we have two hours that we set up and side by side. How does that work out?

The logistics of it are really important. And I think that the most important aspect of living donation is safety. And that really the donor who's doing this amazing generous gift, this lifesaving act, that the team dedicated to that person is only looking at the safety for that individual and that this surgery is not only a wonderful event for them and the recipient obviously, but that it's really a safe event. I describe it as two flights taking off from an airport going to the same locations but each team is uniquely dedicated to make sure that everything is really maximized in terms of the efficiency, the flow of the operation.

Logistically, you're absolutely right. We generally have two operating rooms and the one team starts working on the donor operation, notifies the recipient team as they're getting close to the final steps of kidney removal. And the second operating room the recipient team uniquely is focused on getting that recipient ready and we try to hand off that kidney. So that's very little time between the donation event and between it's hooked up and making all the wonderful things that a kidney should do.

So start to finish, how long will you be in there doing that work?

The donor operation can generally be about two to three hours. The recipient operation ironically sometimes can be shorter than that. But the total day I think generally when I tell patients what to expect I say, around lunchtime someone will be talking to you. And as we all know lunch sometimes is early and the lunch is sometimes late, but that's what we shoot for as a team.

That's great. More questions from viewers. If I want to donate my kidney but I'm not a match for a family member who needs it can I still help someone? And maybe Dr. Kyeso, could we throw this one to you?

Sure, absolutely. So first I want to thank all donors as we are in the month of the donors and I really consider kidney donors as heroes. They are not only saving the life of the recipient, but they're also saving another deceased kidney to go to someone else. And the answer to the question is, yes they still can donate. We have what's called a swap or exchange program if the recipient and the donor they are not a match in terms of their either blood type or in certain cases the recipient can have antibody against the donor. So we can actually bring another couple who are also not a match and swap these kidneys. So we can at the same time transplant two patients by doing this exchange or swap program.

And the other couple, actually they don't even have to be from the same center, so sometimes we swap kidneys from other states. And there are certain cases where we can have three or four different couples, so it'd become like maybe around eight people go in that exchange program and all of them will get transplanted.

Great. Dr. Sam I wonder if you could talk to us a little bit about the team approach that happens here at UChicago Medicine. Dr. Barth alluded to it a little bit earlier in the program, but this is truly a large group of folks that will work with the patient and potentially the donor as they go through this process. And there's a lot involved.

Definitely, I think it seems like a very complicated process but having more of us makes it easy. It's definitely a unique niche where we work closely with our surgeons and we also have other ancillary team members, our social workers, our pharmacists, and financial coordinators. And that enables us to do a total comprehensive evaluation and our most important job is to give our donors the opportunity to ask every question and clarify every concern they have. So this team-based approach gives us the opportunity to do our job well and thoroughly and support our donors and recipients through this process.

That's great. And from-- I guess it depends on the patient probably the time frame that you're looking at, but some of these patients, you get very close with I would imagine because you're working with them and their families for somewhat extended period of time.

And that's one of the joys really of doing transplantation, is to get to meet these donor-recipient pairs. Really get to know them and to think-- they always thank us saying that, thank you for taking care of us. But really it's the donors who are doing this for the recipient and giving the big give and passing on life to someone.

Like Dr. Barth said, coordinating this surgery involves all of this logistics. As a fellow, I've watched the surgeries. And the feeling you get when you watch the surgery similar to like delivering a baby, there's an underlying joy as to when one kidney goes from the donor to recipient and then we continue to see the recipient do so well, taking care of themselves, and we see how their life changes, how someone goes from not being able to do their job to get their job back again, get their lives back again.

And like Dr. Kyeso was saying, not just getting the length of your life back, not just gives you longevity, but also your quality of life really improves. And that's the joy for us to be in this field, is to get to see that every day.

Yeah, that just has to be tremendously rewarding. So Dr. Barth who are the ideal candidates for kidney donation?

That's a good question. I think anyone can be considered as a donor and your viewer had asked a really good question too about the different types of donation. You don't actually even need to know somebody who needs a kidney to donate. And we're seeing that increasingly too, is that altruistic donors who just feel that they've heard the story or there's something in their life that is compelling them to donate.

The first thing is to fill out a questionnaire on your medical history. Our basic premise for the donor is really safety. So we don't want to do anything to somebody who's got underlying serious medical issues. But increasingly, we're finding ways for people to donate that historically we're saying, well, maybe you're a little bit too overweight, maybe you're a little too old, maybe your anatomy to your kidneys is a little different and I think that the team working together is really able to solve a lot of those logistics.

We never kind of take chances on the safety side of things or people of medical illnesses, but really I think just that first step of calling, filling out a questionnaire, and letting us say, you know what, it looks like this would be very safe for you. I tell all my patients, you know people in their lives sometimes hear of their grandmother who died at age 100 with one kidney and those are the people that we know that we want to find who can donate kidneys, that donation will changed nothing about the rest of their life.

That's great. And Dr. Kyeso, it's interesting because I think as we look at the human body there are certain organs obviously like the kidneys that we have two of. But there will be people that will watch this and will say, well, gosh I've got two of them, I need two of them. Can you talk to that a little bit because clearly that's not necessarily the case.

Now, this is an excellent question. And as Dr. Barth said, when we evaluate the kidney donors, our main goal is safety and that they are going to continue a normal quality of life and length after donation. And basically, although we have two kidneys, but in reality many patients or people actually out there in the community they live with one kidney with normal life without having any signs or symptoms of kidney disease and they don't even have any kidney problems. So it turns out that once a patient donates a kidney the other kidney actually in the following few months it starts to work a little bit harder and compensates for the kidney that was donated.

And by about three to six months after the process of donation, the kidney numbers stabilize and we see that on the blood test. So in the immediate period after donation, one of the main numbers that we check we called the serum creatinine and the level of the creatinine. It can increase because all of a sudden the body now has one kidney. But then the other kidney starts working harder and compensates for that. Then we see the nice improvement of the kidney numbers which is the creatinine and one of the main numbers we follow.

And most patients really live normal life. They don't have any symptoms or any side effects or complication from donating that kidney.

That's great. So I am curious and Dr. Barth you can probably answer this one for us. Can an adult kidney be given to a child if you're a parent for example.

Absolutely. And I think that for real children, that's one of the most common combinations we see, parent to child.

How does that work though? Because just the size differential, I think would be challenging.

The size is different. But I think that eventually those children with healthy organ function grow up to be adults and that even though the kidneys are larger the surgery changes a little bit. We can have specialized kind of surgical teams, anesthesia teams, that will focus on that child's procedure. It is a bit unique and requires some additional expertise. But that is one of the most common ways that pediatric transplants occur.

Ironically, in the adult world, one of the most common ways that donation occurs, is an adult child, somebody in their 20s through 50s, maybe older, donating to a parent who may be in their 60s, 70s, or even older. And so that gift that sometimes happens for kids as recipients, is oftentimes we see that for the adult recipients as well.

What a wonderful thing. And that's just really, really neat to hear about that. So Dr. Sam I'm going to let you wrap us up. We've got about a minute left but talk to us first of all just about the importance of donating and how can someone become a living kidney donor?

I think living donation is an amazing thing that one could do, that as an intended recipient or not. Organ scarcity is a real issue. We have a lot of our kidney disease patients who are waiting to get a kidney and I think living donation is one of the wonderful risks for them to be able to shorten that with time, to get a kidney while they're still healthy and they haven't developed further medical conditions while being on dialysis. And it is our job to make it easy if you are thinking about donating a kidney.

So all you have to do is give us a call, let us know that you are interested in being a kidney donor. And we will do the work to go into your history and make sure that we are able to give you the safety net that you need to be able to donate a kidney and determine if you are a good kidney donor and do the process for you, which is why we have a wonderful team and we are here to support anyone who is thinking about kidney donation.

That's great. Well, you three were absolutely fantastic. You did a great job. It was really interesting and you do wonderful work. So thank you to you and a big thank you to those of us who watched and participated in our program today. Please remember, you can check out our Facebook page for our schedule of programs that are coming up in the future. Also, to make an appointment with one of our physicians, go to uchicagomedicine.org or you can call 888-824-0200. Thanks again for being with us today and hope everybody has a great week.

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