In my lengthy experience working with people with kidney disease, I’ve always felt that kidney recipients get more attention and more follow up care than kidney donors. Once the surgery is over, the focus is on the recipient, not the donor. If the recipient has Medicare, when it’s the primary payer Medicare pays 100% for the donor’s evaluation, surgery, hospitalization and 3-months of post-hospital care under a global payment (organ acquisition fee) for a transplant. Medicare covers another 3 months of follow-up billed to the recipient’s Medicare. After that Medicare stops covering follow-up for the donor unless a health problem is directly related to the donation surgery. Therefore, it’s important for the donor to have his/her own health plan. Kidney donors should have the amount of life insurance they want to have prior to donating a kidney because insurance companies discriminate against living donors and transplant recipients for that matter. NKF is working to try to get life insurance companies to not discriminate against kidney donors.
The public is told it’s not a big deal for someone to give a kidney. After all, most people have two. I’ve even heard people say “Share your spare.” It’s important to remember that kidney donors are a highly selected group. They are thoroughly evaluated for current and potential health problems. If a person is accepted as a kidney donor the likelihood is that he/she is healthier at that time than the general public so it’s not surprising that the short-term risk post-transplant is not much higher than risks to an average person. However, there are risks. Research has found that there may be greater long-term risk to living organ donors than previously thought. In fact, here’s an abstract of a recent study looking at risks to kidney donors.
[I]J Am Soc Nephrol. 2014 Sep 25. pii: ASN.2014030227. [Epub ahead of print]
Reassessing Medical Risk in Living Kidney Donors.
Gaston RS(1), Kumar V(2), Matas AJ(3).
Author information:
(1)Division of Nephrology and Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, Alabama; and rgaston@uab.edu.
(2)Division of Nephrology and Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, Alabama; and.
(3)Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
The short- and long-term effects of unilateral nephrectomy on living donors have been important considerations for 60 years. Short-term risk is well established (0.03% mortality and <1% risk of major morbidity), but characterization of long-term risk is evolving. Relative to the general population, risk of mortality, ESRD, hypertension, proteinuria, and cardiovascular disease is comparable or lower. However, new studies comparing previous donors with equally healthy controls indicate increased risk of metabolic derangements (particularly involving calcium homeostasis), renal failure, and possibly, mortality. We discuss how these results should be interpreted and their influence on the practice of living donor kidney transplantation.[/I]
The renal community must do all we can to reduce risks for living donors AND we need to investigate ways to encourage more people to sign donor cards and indicate their wishes to their families so their families will donate their organs (including their kidneys) when they die. A bumper sticker says: “Don’t take your organs to heaven. Heaven knows we need them here.”
There are areas, including California where waiting times for organs is too long. Where I am in Kansas City, median (50% more, 50% less) wait times for a kidney are less than 2 years. Wait times vary based on individual factors. Why is there is such a huge difference between CA and KS/MO? I suspect one factor could be population, including number of people needing kidneys. However, with such a large population, why don’t more people in CA agree to at least be deceased donors? Could any of the approaches used in my area for getting people to sign donor cards or asking families to donate their loved one’s organs at death be used in areas of the country where kidney failure rates may be higher and/or organ donation rates lower so ordinary people who don’t have the resources to multi-list can get a kidney faster? I totally understand that someone who has failing kidneys or is on dialysis and wants a kidney transplant can get desperate and depressed waiting a long time for a kidney during which health problems might arise putting their candidacy at risk. There must be other ways to encourage organ donation besides paying living donors. Paying funeral costs for deceased donors and making those interested in transplants and their living donors aware of the National Living Donor Assistance Center could both help reduce barriers to donation.
https://www.livingdonorassistance.org/