Living Donors and the Transplantation Process
Written by Ella Balasa
This is a recap of the first webinar – “Living with Chronic Kidney Disease: What are My Options? – in the Lyfebulb-Columbia University/New York-Presbyterian Hospital patient information and education series, which is sponsored by Veloxis Pharmaceuticals.
Panelists and moderators included:
- Mark A. Hardy, MD, PhD (Hon), FACS – Auchincloss Professor of Surgery, Director Emeritus and Founder of the Transplantation Program at Columbia University Medical Center
- Karin Hehenberger, MD, PhD – Founder and CEO of Lyfebulb and visiting associate researcher at Columbia University
- David J. Cohen, MD, MA – Professor of Medicine (in Nephrology) and Medical Director of Kidney and Pancreas Transplantation at Columbia University Irving Medical Center/New York Presbyterian Hospital
- Hilda Fernandez, MD – Assistant Professor of Medicine (in Pediatrics) at Columbia University Irving Medical Center/New York Presbyterian Hospital and Vanderbilt Clinic
- Lloyd E. Ratner, MD, MPH, FACS, FICS (Hon) – Professor of Surgery and Director of Renal and Pancreatic Transplantation at Columbia University
- Carly Rebecca McNulty, RN, BSN, CCTC – Senior Pre-Transplant Coordinator at the Columbia Kidney and Pancreatic Transplant program
This session’s discussion centered on end-stage renal disease (ESRD) management before dialysis and transplant, what it’s like living with kidney disease and what can be done to prevent further progression, as well as treating the patient in the disease journey.
The kidney has several roles – one being regulating fluid balance. The human body takes in more salt and water than it needs, and whatever isn’t utilized is excreted in the form of urine. The kidney also regulates mineral content in the blood, such as potassium, phosphorus, and calcium levels and clears waste products of metabolism like proteins and nitrogen. Lastly, it regulates blood counts, preventing anemia. If any of these functions aren’t properly regulated, one reason may be that a person has kidney disease.
In adults, the cause of kidney disease is primarily diabetes, high blood pressure (hypertension), or other autoimmune diseases that cause nephritis, which is inflammation of the kidney. Function can be preserved by maintaining healthy blood pressure and blood glucose levels and monitoring other body functions. In children, the primary cause of kidney disease is congenital issues, which are primarily determined before birth or at infancy due to infections, proteins, or blood found in the urine. A kidney biopsy is the best way to determine the presence and source of kidney disease. Sometimes an ultrasound or a CAT scan can determine the disease as well.
If a patient is showing symptoms of severe kidney disease such as nausea, severe fatigue, and other complications, even with modified medications and diet, then proceeding with dialysis until a kidney transplant is available is the appropriate course of action.
Evaluation for transplant begins when kidney function (measured by “Glomerular Filtration Rate or GFR”) is around 15-20% of normal kidney function, and most people receive a transplant with around 10-15% of GFR.
A kidney transplant can either come from a deceased or living donor. In 2019, 41,000 people in the United States were newly placed on the waiting list for kidney transplants, and there were only about 23,000 kidney transplants done. This means that nearly 20,000 individuals who need transplants are not able to get them each year. The wait time for a deceased donor can be years, and there is a great need for more living donors.
In the last few years, research into genetically engineered organs from animals has advanced. In the first of its kind, a pig kidney was recently transplanted into a human with success, albeit very short term success. This was a temporary experiment, however, and there is still much to learn and advance in this field. Nevertheless, many clinicians and researchers continue to research advancements to make transplants more accessible and successful for patients.
Listen to the full webinar on our YouTube channel here to learn more about innovations and research involving dialysis and kidney transplants! You can also register for future webinars and view all past webinars on TransplantLyfe.