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Low risk, high return

Steve Conroy, with the support of his wife, Paulette, donated one of his kidneys to a stranger. Conroy felt that the “temporary inconvenience” of surgery was small compared with the benefit he could offer someone else. (Photo: Jason Wachter)

A new U study finds that living kidney donors are as healthy as nondonors in the long run

When Lexi Rosenbaum was diagnosed with a rare kidney cancer at 17 months old, her parents felt helpless. Travis and Maria Rosenbaum could only watch as their daughter endured chemotherapy and four surgeries, losing both of her kidneys in the process.

Doctors put Lexi on dialysis—for 11 hours and 10 minutes every night for two and a half years—knowing that she would eventually need a transplant.

Finally, in February, Lexi was healthy enough to receive one of her mother’s kidneys. Maria Rosenbaum never thought twice about the risks of the procedure. “Even when you hear of the complications of surgery, it’s like… she’s my daughter,” Maria says.

Steve Conroy’s decision to donate a kidney wasn’t a difficult one, either. He underwent surgery at the University of Minnesota Medical Center (UMMC) and went home the following day. And the recipient? Well, he’s not sure-Conroy’s kidney went to someone he has never met.

An attorney, husband, and father of four adult children from Monticello, Minnesota, Conroy had known a couple of people who needed kidney transplants and was interested in donating to them if he could. But tests revealed their tissue types weren’t compatible.

“Then I started thinking—‘really, what difference does it make [to whom I donate]?’” he says. “The people I don’t know need it as much as the people I do know.

“It was a temporary inconvenience for me. My goodness, if we can do this for another person, why wouldn’t we?”

These anonymous, or nondirected, donors account for the minority of all living kidney donors. University surgeons have performed nearly 3,800 kidney transplants from living donors—more than any other center in the world-since 1963. Only 49 of those have been nondirected, says UMMC transplant coordinator Cathy Garvey, R.N.

Maria Rosenbaum donated a kidney to her daughter, Lexi, in February. (Photo courtesy of Maria Rosenbaum)

Good news for donors

The University recently released good news for directed and nondirected kidney donors alike. A large study led by nephrologist Hassan Ibrahim, M.D., suggests that there are no adverse long-term consequences of living kidney donation.

The study, published in the January 29 edition of the New England Journal of Medicine, found that kidney donors have survival and kidney disease rates similar to those of the general population. Their risk of kidney failure is actually slightly lower than the general U.S. population’s risk, and they generally score higher on quality of life measures.

Of four published studies on the long-term health effects of living kidney donation, three came out of the University. This study is the most in-depth evaluation of donors’ health and spans the greatest amount of time, tracking 3,404 of the 3,698 people who had donated a kidney at the University between 1963 and 2007. (Another 268 were documented as deceased, and the status of the remaining 26 people was unknown.)

The research team wasn’t surprised by the findings of its study, which was funded by a grant from the National Institutes of Health and a gift from the Alvin and Mona Libin Family Foundation.

“There are a lot of things in medicine that people think they know the answers to,” Ibrahim says. “This was one of those. We kind of knew it, but we didn’t have really solid proof for it. And now we have it.”

Upward trend

The number of kidney transplants from living donors has been increasing throughout the United States and the world for the past decade, according to a study published this year in the journal Kidney International. About 27,000 living-donor kidney transplants are performed per year worldwide, representing 39 percent of all kidney transplants, the study states.

That upward trend is reflected at the University, Garvey says. Of about 200 kidney transplants performed in the University’s hospitals per year, about 125 are from living donors.

“It used to be about half and half, but it’s getting to be more like two-thirds from living donors now,” Garvey says.

That may be because of the shortage of organs from deceased donors, and it may be because kidney transplantation—especially transplants from living donors—is the best treatment for most people whose kidneys are failing, Ibrahim says: It offers a far superior quality of life over dialysis. Half of all kidney transplant recipients live at least 10 years after getting a cadaver organ or at least 25 years after getting an organ from a living donor, he says.

The reasons behind the difference are unclear, but Ibrahim thinks three factors contribute. First, living donors must be extremely healthy. They cannot be overweight or have diabetes, hypertension, other medical conditions, or any sign of an underlying kidney problem, so the kidney they donate is in excellent condition. Second, a kidney from a living donor does not need to be preserved long before it’s transplanted into the recipient because the donor’s and recipient’s surgeries are scheduled to happen almost simultaneously. And third, living-donor transplants are usually done under ideal conditions—the surgery is scheduled in advance; whereas transplants from deceased donors are scheduled immediately after a donor’s death and are ideally done within 24 to 48 hours.

Research led by Hassan Ibrahim, M.D., suggests that there are no adverse long-term health consequences of living kidney donation. His study has received attention from media around the world. (Photo: Scott Streble)

Heard ‘round the world

Ibrahim hopes that his team’s findings will create more interest in living kidney donation research. Next, he wants to follow more donors and a more diverse group of donors. (Donors in the University’s study are almost exclusively white, as are 86 percent of donors in the United States.) And now that the current study has shown no adverse long-term health consequences of living kidney donation 30 to 40 years out, the team wants to know if that holds true 50 or 60 years later as well.

The group’s research already has garnered interest from around the world. Besides receiving media attention from several of the United States’ largest newspapers, The China Post, Calgary Herald, Iran Daily, and other international media also covered the study.

And locally, media coverage has attracted interest from a few potential organ donors.

“We’ve had four or five calls from people who are interested in becoming kidney donors,” Ibrahim says. “And when I daydream, I think, well, if every transplant center gets two to four or five calls a year, and half of these come to fruition, that’s another few hundred transplants done to take people off dialysis. That’s the ultimate goal.”

For Conroy, the man who donated a kidney to a stranger, these studies confirm his decision. He says he had educated himself on the costs and benefits of living donation and felt that the cost to him was small compared with the benefit he could offer someone else. He was in the hospital only overnight and was back at work about a week later. After a few follow-up appointments, he’s back to his normal life.

And Conroy says he’d “absolutely” make the same decision again.

“People are good-hearted,” he says. “If people really knew what they could do for other people, they would do it.”

By Nicole Endres

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