Donating a Kidney: Part III

All is well. With the surgery behind me I can now look forward to the upcoming school year, which will be my twentieth year as a student (I have got to get a job).

Since last Tuesday I have been off medication, and my mobility has continued to increase daily. As you can see from the pictures below my incisions are quickly becoming scars. The two smaller incisions are exactly half an inch long and the exit incision is a little longer than three inches – the surgical doctor bragged before the surgery that she had very small hands.

After the leaving the hospital I haven’t heard from or anything about the recipient. Of course, Gift of Hope has my contact information and I could potentially be contacted at anytime; however, because I was always been ambivalent to meeting the recipient I am not disappointed.

In the next few weeks I am going to begin posting on why kidney markets are both viable and ethical means to addressing the acute shortage of kidneys. Much of research was done last year while I began to reflect on my decision to donate.

Donating a Kidney: Part II

Two days ago my kidney was removed. Two hours after it was removed it began to filter blood and produce urine for a fifty-year old man who I have never met. We live in strange times.

My first post stated that my surgery was for Friday, but unexpected cadaveric donations came up and pushed my operations to Tuesday. Of course, one should be happy that more transplants took place and at the same time, cadaveric donations also inevitably signal death. A mixed of macabre and miracle; something thoroughly Christian in it all, too.

Of course the change in the surgery wasn’t a problem for me, because I had already taken two weeks off from work for recovery, but it meant my girlfriend Amanda would not be able to stay with me during my overnight stay at the hospital after the surgery. If I rescheduled I wouldn’t have time to heal before school started so the date was set for Tuesday, August 7, 2007.

The day before the surgery Amanda and I had a quiet day reading and cooking. I felt little stress, and was looking forward to my operation. In the evening I stopped eating solids and at midnight I stopped drinking liquids. It stormed most of the night, and though ominous I felt at peace with my decision. I awoke at 3:30 in the morning not being able to sleep any longer. At 4:30 we took showers, dried and dressed. We left at 5:15 and arrived at the Surgery Reception Desk at 6:00.

After signing a few medical forms I was escorted, with Amanda, to a pre-op room. There I was asked to exchange my clothes and bracelet (that I never take off) for a flimsy gown that made me feel pasty, weak, and emaciated. While I changed Amanda, who is a nurse, looked innocently at my medical records, and accidentally found that the recipient’s name, age, and gender. Later, she would tell me that she saw his family in the waiting room, being told that the retransplantation would begin.

Back in the pre-op room there was thirty minutes of doctors, nurses and attendants who kept asking the same ten or twenty questions; What is your name? Any medical allergies (yes, Keflex), Who are you donating you kidney to? Every time I answered the question by stating that I was a non-direct donor they would respond, “Oh, how, um, generous.” Then I was given an IV line and kissed Amanda goodbye. During the entirety of the procedure I felt qualm, sure about my decision, happy that my year of contemplation was coming to fruition. The last thing I remember was entering the machine-laden operation room and placed on the table, being strapped down and then… …

I awoke peacefully. There was almost no pain. The recovery room was loud and I sensed it was large though I couldn’t tell because of the curtains that surrounded me. My nurse, Kim was talked with in bursts of sentences; “How are you? Doing well? I am giving you a pain medication. You will get a private room soon.” Then I was alone. In front of me was a nurses’ station, and I continually and groggily kept smiling and waving at nurses and passers-by. Finally, Amanda came back to the recovery room. I proudly, if not dumbly, lifted my gown aside to show her three incisions. The larger one cut across my lower abdomen and was no less than five inches. My surgeon; doctor Baker came in to tell me that the operation went well. My kidney’s renal artery was naturally split in two (which isn’t uncommon) and she had needed to do some work to splice into one, but that that too had been successful.

A new nurse took over for Kim, her name was Faye. She had just been married in Israel, and through honed skills of deduction I surmised she was Jewish. We talked about Jews weddings, which after seeing one at the age of fourteen always found preferable to protestant, though not Catholic weddings. After arriving in recovery at around 10:00, I finally was wheeled to my hospital room at around 2:00 p.m. Still groggy, and beginning to feel some pain, I made a number of calls to family and friends to inform them that I was still alive.

In the early evening I began to reel. My friend Krista came to visit – bless her heart; and by bringing me flowers concurrently took a personal stand against gender stereotyping. Yet, as the anesthesia began to wear off I felt discomfort and pain. The anesthesia led to dry-mouth and nausea, and Krista had to watch me reject a lovely serving of apple-juice and Jell-O (She’s quite a good friend). That evening I had to ask for more pain medication because I couldn’t fall asleep. Around 4:00 a.m. I finally was able to rest.

The next day another friend, Ted, came to visit and by 1:00 in the afternoon I had taken a shower, eaten and was urinating normally. These were three goals before being discharged, and soon I was being driven to Indiana by my brother John. After arriving at Amanda’s house I promptly fell to sleep.

Today I have taken things slowly, as I shall do for the next three to four days. On Monday I have a check up, and will return to work on Tuesday if I continue to improve as expected. Ultimately, the experience was a positive one. In economics they call these types of transactions Pareto-efficient, meaning that all parties ended better off than how they started. Perhaps the old adage is true: It is better to give than to receive.

Donating a Kidney: Part I

If you do yet not know I am donating a kidney. The surgery is this Friday.

This decision was borne from the brain-child of one Maryanna Ramirez (Maryanna, consequently, is the type of friend one thanks their lucky stars for: beside her infinite ability to forgive she has impeccable taste and a long history of promising and datable roommates). Maryanna almost a year ago mentioned that in the medical field there are ethical debates surrounding the permissibility of organ markets. She mentioned that genesis of such medical ethics came from a book by Richard Titmuss entitled, "The Gift Relationship." She also mentioned Sally Satel who currently write for the American Enterprise Institute and has written in favor of organ markets – specifically (if not exclusively) kidney markets.

Thus was my introduction to the world of kidneys. Now, Maryanna knew such an issue would fascinate me for three reasons: 1) it involved economics 2) it involved ethics 3) it was a generally contentious subject.

In the following weeks I read not only the Titmuss and Satel pieces, but everything else on living laparoscopic nephrectomies, which is the medical operation kidney donors undergo. After my initial foray into the world of organ donation two things became abundantly clear: there was a shortage of kidneys and I could relatively safely donate one of my kidneys.

First, lets talk about the shortage of kidneys. End-Stage Renal Disease (ESRD) is a catch-all medical condition for kidneys that are failing or not functioning to such an extant that dialysis or transplantation are necessary. Though cadaveric donation and living relative donations meet much of the demand for kidney transplantations about 4,000 kidneys annually are still needed. Dialysis is the only option for those waiting on the list or who have no option of being a recipient. Further, dialysis – though a wonderful medical invention – marketedly decreases life expectancy, quality of life, and in the long run costs more, on average, than transplantation. The number of ESRD patients who annually die waiting for a kidney is nearly the same as the number of US military deaths in Iraq in the past four years – around 3,600.

Second, a living laparoscopic nephrectomy is a relatively safe procedure. Besides the chance of death being effectively 0%, complications are exceedingly rare. The two hour long procedure consists of two half-inch incisions (for laparoscope and surgical tool) and one four to five inch incision (for kidney removal). Most post-operative pain is not due to the incision, but rather the carbon-dioxide gas used during the operation to literally inflate the chest cavity. A donor stays over night and discharged the next day. In one to two weeks of rest donors can return to work (required it involves no heavy-lifting) and in four to five weeks donors can return to rigorous exercise.

For these two reasons I decided a year ago that I would donate my kidney. On Friday that promised decision will become a reality. Per a friend’s request that I blog the process I am going to do just that. Thus, I will be updating the process throughout the week, and would love to take questions you may have.