April is half over! In closer to normal years, people throughout the United States would be rushing to get to a post office to have their tax returns postmarked before midnight. It’s not a normal year. For the second April 15 in a row, it’s not been a normal year. For some.
Then there are some 107,000 people who would like today to turn extraordinary before midnight. Those are the people waiting for a transplant. Wait. Make that 107,001. About every 9 minutes another person is added to the list, another person moves another step away from normal. By the end of tonight 17 people will move off the list but not because they got their transplant.
If the numbers don’t get you – 107,000 waiting for transplant, a new person added every 9 minutes, 17 people dead each day because they did not get their transplant – how about this? April is half over. April is National Donate Life Month. There’s a Presidential proclamation and everything even. How many times did Donate Life Month headline a news report this month? How many people took to the streets to protest the needless loss of life of seventeen people yesterday, and the day before, and before that and before that and the one before that too? How many times did you even hear about Donate Life Month before today?
Last year, 39,000 transplants were performed. I’ll do the math for you. That’s 106 transplant operations each day. At one added every 9 minutes, that’s 160 new additions to the transplant list. Every day we add 54 more people than we are transplanting. That’s why the average waiting time for a kidney, which is the most common transplant performed, is 3 to 5 years. (Since I know you’re curious, lung and heart transplant waiting lists are about 6 months, pancreas about a year, and liver close to 5 years. Of course, a patient’s time on a waiting list is a factor of organ needed, blood and tissue type needed, and severity of illness.)
Saving lives is rarely a trending topic of Twitter, there are not many infographics on giving life on Facebook, and I haven’t seen one of those “How You Can Help” Instagram posts on alleviating the pain and suffering of up to 8 people with one act. More actually, and some even while you’re still alive!
The number that gets thrown around a lot is that every organ donor can save 8 lives. One heart, two lungs, a liver, a pancreas, two kidneys, and the intestines. You can add to that two cornea, a lot of skin and a handful of other non-categorized tissues like the abdominal wall. That’s from a deceased donor. Want to be a hero and still be around to feel good about it after the transplant. Living donations aren’t restricted to kidneys although they are the most common living donor organs transplanted. In addition to giving a kidney to transplant you can also donate a portion of your liver, pancreas and intestines, and one lung, For the most recent period, March of this year, the Organ Procurement and Transportation Network of the U.S. Department of Health and Human Services, reported 9,878 transplant surgeries of all types performed for March 2021 from 4,740 donations.* But that’s just solid organ donations. You can also donate bone marrow for transplant. And if all of that seems too icky for you, there’s still blood donation.
Don’t let the second half of Donate Life Month go by as innocuously as the first. Do something. At the very least register to be an organ donor after life when you renew your drivers license. For more information on solid organ donation and transplant in the United States go to https://www.organdonor.gov/. You won’t make the news, nobody will say you name, and there will not be parade in your honor. Do it anyway.
* How can you perform more surgeries than you had donations? From living donors you can’t, but from deceased donors you can transplant multiple organs. In March there were 1,463 living donors responsible for 1,478 transplants (multiple living organ donations are rare but possible with kidney/pancreas transplants) and 4,740 deceased donors contributed to 9,878 transplants.
While the donor’s surgeons are finishing their procedure the recipient’s receiving location is prepared by a second surgical team. The recipient surgery is performed through an open incision and two attending transplant surgeons, in my case one of them also a urological surgeon, will operate. Unless there is a medically necessary reason, the recipient’s native kidneys are not removed. The donated kidney will be placed in an abdominal lower quadrant, usually the right although in my case because of previous surgeries and that space already occupied, it will be placed in the left lower quadrant. The renal vessels and ureter from the native kidneys are transpositioned and the recipient is closed up and sent off to recover.
So now that it took you so long to read about the process you may better understand why it is taking so long to complete the process. Each of my donor candidates was stopped at some point in the evaluation. One proceeded all the way to the CT Scan when a shadow was noted on a neighboring organ. The transplant committee interrupted the process and referred her to a specialist who in turn determined the shadow was not clinically significant and recommended her to continue which the transplant committed approved. One was held at the renal function test when the IV mediated glomerular filtration rate returned a slightly elevated result. The committee referred the result to one of its own nephrologists who recalculated the result and determined due to her physical structure it was within normal limits for her height, weight, and age and recommended to continue. One potential donor returned elevated 24 hour blood pressure results. She was allowed to move on to the renal function tests but had to reschedule a repeat 24 hour blood pressure monitor. The second 24 hour blood pressure results also returned elevated and she was referred to her cardiologist. Pending his review and finding, even though by this time she had passed the renal function tests, she was held from further candidate progress. Ultimately her blood pressure could be maintained within the standards expected for a kidney donor only with the use of two medications thus she was removed from the candidate pool.
The unfortunate thing about dialysis catheters is that unlike say administration ports one might receive chemo through, they terminate outside the body and do so on a pair of tails. I’m posting a drawing so you can better see what I am trying to describe. (I could take a picture of my actual catheter but it’s not a selfie I’m anxious to snap and if you just type “dialysis catheter” into your favorite search engine you’ll get no end of new disgusting pictures to peruse at your leisure.) The part of the catheter inside floats and can actually be felt depending in where the tip resides at any particular moment. Reaching for anything higher than one’s shoulder, which given my modest height is anything off the counter, means moving the catheter around in there, also rather obviously noted. And because there is really no good way to anchor the outside tails, any movement or position change comes with a reminder that there is a part of you that isn’t really a part of you.
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