Spare a Kidney?

By Christine Gorman

My friend Jennifer (not her real name) is a very generous person, but I wasn't prepared for the bombshell she dropped on me the other day. "I think I'm going to donate a kidney to my former boss," she told me. "What do you think?"

Talk about giving at the office, I thought. But what I said was "How close are the two of you? How much do you know about what's involved?"

More people are asking such questions these days. It is no longer unusual for a spouse or relative to donate a kidney to a loved one, but the number of Americans who have given a kidney to a friend, a co-worker or even a complete stranger has risen sharply--from 68 in 1994 to 176 in 1998.

There are many reasons. First, it's possible to live a normal life with only one kidney. (The remaining kidney enlarges to make up most of the difference.) In addition a kidney from a live donor lasts longer than a kidney taken from someone who has died suddenly. But the biggest change in the past few years is that transplant surgeons have started using laparoscopic techniques to remove the donor kidney through a much smaller incision, and this can cut recovery time for the donor from six weeks to four weeks.

Just because you can do something, however, doesn't mean you should. Donating a kidney means undergoing an operation that carries some risk. You could argue that you may be helping to save a life. But you certainly can't pretend that you're better off with one kidney instead of two.

So, what are the risks? "As with any major operation, there is a chance of dying, of reoperation due to bleeding, of infection, of vein clots in the legs or a hernia at the incision," says Dr. Arthur Matas, director of the renal-transplant program at the University of Minnesota Medical Center in Minneapolis. Even laparoscopy, a relatively new technique for kidney donation, is not risk-free. Doctors estimate that chances of dying from the procedure are about 3 in 10,000.

There's no money to be made; selling an organ is illegal. But the recipient's insurance normally covers your operation and immediate aftercare. Your costs can include hotel bills, lost pay during recovery or possible future disability.

Although transplant centers must evaluate any potential donor's suitability, it never hurts to have an independent opinion. The most common contraindications are heart disease, diabetes and high blood pressure.

Never let anyone, not even a close relative, pressure you into giving up an organ--no matter if you're healthy. "There's often the feeling that you're not a good friend, father, mother if you don't do this," says Arthur Caplan, director of the University of Pennsylvania's Center for Bioethics. Some transplant centers will invent a "medical problem" on behalf of those who are reluctant to donate but feel they can't say no.

So, what happened to Jennifer? After consulting her doctor and learning more about the risks of surgery, she decided not to go through with it. It was absolutely the right decision for her.

Last fall my colleague Dr. Ian Smith wrote in this space about how to find a good clinical trial. Now there's a website that makes this easier: www.clinicaltrials.gov For more information on giving away your extra organs, visit www.unos.org