QUESTION: Kidney Transplant Shenanigans

QUESTION from a writer:

I’d love your thoughts on a story line:
Wealthy mom pays young man to find a living donor for her teenage daughter, who needs a kidney (they have no living relatives and mom doesn’t match). I’ve done some research on this and I am still amazed at the altruistic people who will donate a kidney to someone they don’t even know. However, in the story, the donor is a gullible young woman living on the edge who simply needs money and pretends to be a “friend” donating a kidney. Of course, blackmail and murder will follow when the donor discovers that the middleman took most of the money.

How grueling is the matching process?
Depends on what you mean by grueling 🙂  The person must undergo the following:
  • Blood typing (twice)
  • Medical evaluation – looking into medical problems that could be transferred (e.g. prior kidney disease, cancers that run in the family, blood pressure, etc) but also any risk factors for diseases like HIV, Hepatitis C, and even foreign travel.  It’s quite thorough, but lying is always a possibility I guess.  Labs are tested, ECG, Chest X-ray, imaging of the kidneys, etc.
  • Psychosocial evaluation – includes risky behaviors again, alcohol, drugs, they ask whether the decision to donate is free of undue pressure (ask reasons for donating), assess their ability to consent
  • Assignment of a ILDA (independent living donor advocate) to advocate for them through the process. This is provided by the hospital, but can’t be associated with the recipient.
If a person was a drug user in the past but was not using any more, could that person be a donor?
Yes, but it does put them at higher risk of HIV, hepatitis, etc.
Is it possible that mom wouldn’t match? (I could always make her a daughter by adoption.)
Absolutely possible that mom wouldn’t match
What would the recovery be like for the donor? and the recipient? what would the scars look like?
This depends on how they do the surgery. We do most (90+%) donor nephrectomies (removal of kidney) laparoscopically now, so the scars are just a few 1 inch lines on the abdomen and side and one larger one to pull the kidney out.
The scar for the recipient will be on the lower abdomen. Almost always on the right.
Stay in the hospital is a few days, then 4-6 weeks off work on pain meds. The pain is actually worse for the donor than the recipient.
Follow up clinic visits after that.
 How long does this living donor surgery take?
1-4 or more hours depending on the experience of the team, the weight of the patient, scar tissue, etc. – whether they’re at a teaching institution and it’s July when all the residents advance.  NOTE: Avoid teaching hospitals in July – says the none-too-brilliant obstetric anesthesiologist who delivered a baby on July 3!
How many people would be on the medical team for this procedure?
Anesthesia provider (anesthesiologist possibly with a nurse anesthetist, though only one would stay in the room), scrub tech, circulating nurse, surgeons x 2 (+medical student if in an academic center).  There would be a team in each OR.
Note that often the donation is done in one hospital, and the organ flown to another. The person to transport the organ would be in addition.
 I’ve read about young people damaging their kidneys by excessive drinking. Is this true or just the Internet talking?
True! The kidneys have to filter the alcohol, this filtration function can be affected. Also, dehydration, as can be caused by alcohol, is bad for kidneys. Alcohol can also cause high blood pressure which is bad for kidneys as well. Finally, liver disease is common with alcohol and it causes problems for the kidneys.  According to the National Kidney Foundation, “most patients in the United States who have both liver disease and associated kidney dysfunction are alcohol dependent.”
I’d like the operation/recovery to take place at a private clinic or even in a medical suite in the wealthy woman’s home (we are talking exceptionally wealthy). Is this WAY out of the range of possibility?
Wow, that would be impressive. Not completely out of the realm of possibility, but definitely in the fiction world. Not many docs would be willing to work outside their own hospital, so you may end up needing to use disreputable docs, in which case all the donor/recipient safeguards may be moot and you can do whatever you want 🙂  An awful lot can go wrong that would require other resources…blood bank, other surgical equipment, stat laboratory results, an X-Ray…I certainly don’t know anyone willing to do something like that.  You might be able to envision a super-fancy hospital with a separate suite for big wigs, but still in a hospital – but then, we make the world as we want, right??

 

 

 

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3 thoughts on “QUESTION: Kidney Transplant Shenanigans

  1. paul

    My wife had FGS (I know what it means but I can’t spell it) and needed a kidney transplant. It took almost 17 years for the disease to run its course to the point where a transplant was advised. Our daughter gave her the kidney. Everything the good Doctor said about the operation, pain, recovery etc is correct, but I would like to add a perspective from the caregiver and in this case the husband and father. I am retired Army and spent two years in combat during Viet Nam and I was never as frightened as I was the day they wheeled both my youngest daughter and my wife into operating rooms at the same time. Getting shot at (and hit) it a piece of cake compared to that. My daughter was married so her husband helped with her care, but I did my wife’s. The process was hard on both of us, her because of the surgery and me because I was an Infantry officer. I was not used to being a caregiver. Med around the clock. Ever give a person you love a shot in the stomach? Change dressings? Empty bags? And don’t even ask what massive does of Prednisone does to the patient and everyone around them. But….it’s been ten years and we all survived. If you have not already, sign up to be a donor after all, your body parts are worthless once you take that last breath.

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  2. Shari Randall

    Many thanks, Paul, for sharing your experience, and Tammy, for your answers to my questions. I loved your last line – we fiction writers do make the world as we want. I just read your previous post about The Nightingale. I can imagine how you and other medical professionals approach books and films with knowledge which must just make you shake your head in disbelief sometimes.

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