Melanie Cole (Host): Over 100,000 people in the U.S. are waiting for kidney transplants and there is tremendous kidney organ shortage. My guest Dr. Juan Palma. He’s a transplant surgeon at Maine Transplant Program at Maine Medical Center. Welcome to the show, Dr. Palma. Tell us a little bit about kidney transplants. What’s going on today and what’s new and exciting?
Dr. Juan Palma (Guest): Hi, Melanie. Thanks for the opportunity. There is good and bad news as usual. The good news is that 2016 was a record breaking year for organ donation. About 30,000 transplants were done all over the country for the first time. So, that’s the good news. The bad news is that, unfortunately, the demand for organs continues to grow at a faster pace than the organs are available. So, the gap between the need and supply, unfortunately, every year keeps getting bigger and bigger which translates into increasing waiting times for transplants for those patients while waiting for that life-saving organ.
Melanie: Now, tell us what would send somebody to need a kidney transplant? At what stage in various kidney diseases does it come down to getting on a transplant list?
Dr. Palma: The two leading causes of kidney disease in the United States are diabetes and hypertension. I’m sure that we all have friends or family or relatives that, unfortunately, may have one of the two. There are other diseases that affect the kidneys but, like I said, diabetes and hypertension encompass about 60, if not more, of the percentage of patients that will lead to chronic kidney disease. When you develop chronic kidney disease, the remainder of your kidney function is measured so when you fall below 20%, that’s when the patient should start looking for an alternative. In this case, either dialysis or transplantation.
Melanie: How long can someone be on dialysis?
Dr. Palma: An excellent question. It depends on the patient’s body reserve. Younger people that have less medical problems, they may last longer in comparison to older patients that may have additional heart problems, lung problems that may complicate their survival. On average, patients may last as little as 3 to 4 years, or as long as 11+ years.
Melanie: While dialysis is certainly an option, it’s very inconvenient, even with home dialysis treatments now, Dr. Palma. So, tell us about the transplant situation. What’s going on now as far as living donation versus using somebody who’s just died?
Dr. Palma: Okay. I think that I would like to take a step back. The kidney transplantation, in general, the two main reasons that we promote transplantation as the best modality of treatment of somebody that is facing dialysis is based on a survival advantage. There is plenty of literature and data that supports that for patients who receive a kidney transplant, the survival is significantly increased in comparison to somebody that stays on dialysis. So, there is a clear survival advantage. Number two, like you mentioned, their lifestyle improves greatly because they don’t need to be captive into their dialysis schedule where most people can be as routine as everyday versus every other day. They cannot travel. It takes a toll on the body. So, their lifestyle and their quality of life improves greatly. So, those are the two main principles why we support transplantation. The third one, if you look at it from the healthcare prospective, transplants, in general, if they are successful they save money. Medicare is the main contractor because anybody that goes into dialysis, usually Medicare covers the expenses. So, in general, patients if they get transplanted, after the three years Medicare costs drop to keep those patients going with anti-rejection medication in comparison to patients who still remain on dialysis. So, there are multiple benefits.
Melanie: Now in the donation process, people have to look for a matching donor and whether they’re on the organ donation list, which can be a long, uncertain wait, Dr. Palma. What about living donation? Can the person donating live with just one kidney?
Dr. Palma: That is correct. That is a correct statement and it has been proven over many, many decades. The first living kidney transplant that was done here in the United States goes back to 1954 and the recipient kept the kidney for more than 2-2 1/2 decades and the donor did well. We have more than 60 years of track records on living donation in this country. Living donation in 2016 is safer than ever. The donors are screened very carefully. We test every single one of our donors to basically assure them that, although there is always a risk involved with kidney donation, that risk is minimal and it will have minimal repercussions for the rest of their lifetime.
Melanie: So, if somebody just has one kidney and their a family member and they’ve donated a kidney to a family member, is there a genetic component to kidney disease that now that person that’s left with only one kidney is at risk for kidney disease themselves? I mean, I think that’s a big concern for people.
Dr. Palma: Correct. When I evaluate donors on a daily basis, again, part of the donation risk assessment includes what you mentioned. Is there a genetic disorder that is carried within the family so then the donor will be exposed to the same risk as the relative that is already facing dialysis? Fortunately, very few genetic diseases are the result of end stage renal disease. Like I said before, the most common ones are diabetes and hypertension and there are multiple factors other than genetic. Absolutely, if there is a strong family history of kidney disease, we take that into consideration to make recommendations about the risk for that particular living donor.
Melanie: Living kidney donors provide the recipients a better chance for survival as more than a deceased donor, is that true?
Dr. Palma: That is correct. The average, the half-life, so basically 50% of the kidneys from living donors, they are functioning on average 18 out of 18 years versus 10 years from a deceased donor. That is an important point because when you have a young patient that is already facing dialysis, having a living donor may open the door for that patient to stay away from coming back to the transplant wait list, hopefully, for forever. If you get a deceased donor transplant at a young age, most likely you will come back again after 10-15 years and reenter the wait list. That is one of the main problems we have. About 20% of our patients on the wait list are, unfortunately, a patient that they require a second, a third, sometimes a fourth kidney transplant. So, living donation is clearly a better alternative and it will help us all to keep patients away from coming back to the wait list and, hopefully, that situation will not happen.
Melanie: Does the living donor have to pay for this surgery?
Dr. Palma: That is an excellent question. No, the cost of the evaluation itself--all the testing, CAT scans, bloodwork, clinic visits and the surgery itself and the hospital admission--they are all paid for the recipient’s insurance. There is, however, some items that are not covered by the recipient’s insurance. The main one is their wages, their salary wages are not covered by the insurance. So, basically, the donor has to have the funds or the time to do this procedure. Typically it takes donors four weeks out of their working environment.
Melanie: So, they have to be able to miss work in that case and we only have a few minutes left Dr. Parma. It’s such a fascinating subject. What would make somebody, a stranger, want to give – you must have seen this in your practice – want to give a stranger one of their kidneys?
Dr. Palma: That is actually the reason I chose transplantation. It’s a very uplifting specialty. I cannot answer that question because I think that the living donors and donors in general are special people. They make the decision. The decision is completely out of any financial or personal gain. They just do it because they keep telling me it’s the right thing to do. “I have two kidneys and somebody is needing help” so that altruism, I think that we all learn from these living donors. Maybe we can be a better world altogether. It is fascinating. There are multiple reasons why these people want to donate but I think that the bottom line is that they are just good people that want to help.
Melanie: I think so, too, and I applaud all the great work that you’re doing. In just the last minute here, give your best advice for people who might need to have a kidney or people considering donating one of their kidneys and why they should come to Maine Medical Center for their care.
Dr. Palma: For the patients that have been diagnosed for the first time with chronic kidney disease, try to as healthy as possible. Try to control the diseases that may be the source of the kidney damage. I’m talking about diabetes, high blood pressure. An ounce of prevention goes a long way. So, you know that your family has diabetes or hypertension, try to stay on your ideal weight. Exercise and have healthy habits so, hopefully, you can prevent kidney disease. If you want to be a donor, the best advice that I have is to contact a transplant program. We can provide you all the information that you may need. We have from social workers to financial coordinators to physicians, so we can answer every question that you may have. I think that my program at Maine Medical Center, one of the things that we are proud about is our results are among the best in the nation. But, more importantly, because we are on the small side, I think that we provide personal care. We know all of our patients by name. They know us by name. It is not like going to a large program when they can be lost in the shuffle. I think that we provide excellent patient service and I think that is the key to our success.
Melanie: Thank you so much. What great work you’re doing, Dr. Palma, and thank you so much for being with us today. You’re listening to MMC Radio and for more information you can go to mmc.org. That’s mmc.org. This is Melanie Cole. Thanks so much for listening.