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School of Medicine
Living Kidney Donor Surgery [Transcript]
Featuring Dorry Segev, MD, Assistant Professor of Surgery
Describe what you do.
I’m Dorry Segev. I’m a transplant surgeon here at Johns Hopkins. I do kidney transplantation, primarily live donor kidney transplantation.
What are the two types of kidney donors and what are the advantages of each?
If you’re in need of a kidney, you can have a living donor kidney transplant or you can have a deceased donor kidney transplant. The advantage of a living donor transplant – well, first of all it’s a scheduled operation, you don’t have to be on-call for an organ - and you don’t have to wait a very long time on a waiting list in order for a donor to become available. If you have a donor that’s for you, you can get that transplant immediately. But the biggest advantage is that a kidney from a living donor lasts approximately twice as long as a kidney from a deceased donor.
How many people are currently on the transplant list waiting to receive a kidney?
If you have a loved one or a friend who is in need of a kidney transplant, this is just a sense of what they’re facing: The current waiting list is 90,000 people long. For some people who join the waiting list, the time waiting is so long, that they are actually more likely to die while waiting than they are to receive their very first organ offer. The death rate on dialysis – it obviously depends on the patient – is somewhere between 5% - 15% per year, so that’s every year, they are attached to that machine, they have a 5% - 15% chance of dying on that machine.
Donating a kidney to somebody, as a living donor, statistically doubles their life expectancy. So if this is something that somebody’s considering, you can really make a huge impact on somebody’s life with this profound gift.
What are some reasons why someone might donate one of their kidneys?
We get several kinds of people come to our clinic interested in donating. Some people have a relative, or a loved-one, or a friend that they know needs a kidney transplant. And, surprisingly and heart-warmingly, some people just come to our clinic and say, “I feel very lucky and blessed that I’ve been healthy my whole life. I have two kidneys and I want to give one of them to somebody that needs a kidney.” And every year, there are actually about 100 people in this country who come forward as non-directed donors. As altruistic donors, they just want to give their kidney to somebody else. Those are really the two big motivations that bring people to our clinic.
What are the misconceptions or risks of kidney donation?
So if you want to donate a kidney, obviously the first question is, “What are the risks in doing so?” Suffice it to say, that living with one kidney, after donating a kidney, if you are healthy and you are not destined to get any major diseases is going to be the same as living with two kidneys. We did a study last year of about 90,000 patients, and the question we asked was two-fold. One, what is the risk of the operation itself? And what we found was that this is one of the safest operations that you can possibly have in the operating room because of the health of the donors and the experience of the surgeons. The second thing we found was that living down the road with only one kidney did not put anybody at excess risk of dying prematurely versus living with two kidneys.
Describe the surgery to remove a donor kidney.
When somebody wants to donate a kidney, at Johns Hopkins, we do this operation laparoscopically. What that means is that we put a camera into the bellybutton and that camera can see all of the organs inside the belly. We make two more tiny little band-aid incisions. Through those incisions we put long instruments where we can control those instruments from the outside and they do the movement on the inside that we can watch on a monitor. With those three little incisions, we can basically free the kidney up to get it ready to be removed, but then we have to remove it whole, so that we can transplant it to the next person. When we are ready to do so, we make about a 2 inch incision at the very lowest part of the belly - the bikini line area - and through that incision we remove the kidney. When the kidney is out we close everything back up again and the operation’s over.
What is the recovery like for kidney donor surgery?
After donating a kidney through the laparoscopic operation, one day after the operation, people are already up and about, walking around, you might even be able to visit your recipient. You’re drinking. You don’t have much of an appetite but you can eat food. Most people, two days after the operation leave the hospital. When they see me again in clinic about a week later, they are feeling pretty good, they are ready to get back to most of their regular activities, although they are feeling a little bit tired and the energy level is quite low.
For the first fix weeks after the operation, you can’t lift anything heavier than five to ten pounds. After that six week period, life is as it was before donating.
How has the kidney exchange program helped save lives?
So about ten years ago, here at Hopkins, we did a kidney swap, where we took two people who were incompatible and we swapped them so that they could be compatible. Since then, this has spread worldwide. In the US – just even in the US – since then, there have been over 1,000 people who have been transplanted through that kind of system. That’s made that possible that none of those thousand transplants would’ve been made possible before.
What is the most rewarding thing about what you do?
The most rewarding thing about operating on live donors is giving somebody the opportunity to help another person. I have a tremendous about of respect for live donors. A live donor is a healthy person that wants to help another in need and I like to know that we have an operation that can help that person help another.
What do you consider your greatest accomplishment?
I’m most proud of the fact that I’ve been able to dedicate my career both in a research manner and in a clinical manner to the care of living donors. So I operate on living donors, I’ve helped develop the operation into what it is today, and I’ve also done a tremendous amount of research into living donors. We all wonder when somebody donates one of their kidneys how they are going to do long term. We published in the Journal of the American Medical Association last year, a huge study of 90,000 living donors, we continue to follow living donors. So not only do we make this opportunity possible, but we’re able to follow people and help them medically down the road.
Why should a live kidney donor choose Johns Hopkins?
The greatest part about doing live kidney transplantation at Johns Hopkins is that we have made efforts in the last ten, twenty, thirty years to take people with a burning desire to donate a kidney to their loved one and to make this possible. So, for example, it used to be if you were the wrong blood type, you couldn’t donate. Well that’s very devastating if you want to donate to a family member. So we’ve come up with novel ways of making this possible. We can desensitize somebody to an incompatibility. We’ve developed a national algorithm for exchanging kidneys to help people find another donor that might be the right one for them. We keep pushing the envelope to make it possible for somebody to donate a kidney to their loved one, and that’s what’s great about working here.
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