Research Profile - I love you with all my kidney
Dr. Amit Garg
The largest-ever study of what life is like for people who donate kidneys will help these donors live long and healthy lives after their selfless acts of kindness.
For those who fear the world is going to hell in a handcart called self-absorption, here is heartening news: one of the most remarkable acts of human kindness is on a steep upward trend.
"There's been a dramatic increase in living kidney donations both in Canada and globally over the last decade," says Dr. Amit Garg, Director of Lawson Health Research Institute's Kidney Clinical Research Unit at London Health Sciences Centre. "About 40% of all kidney transplants in Canada are now coming from living donors, as opposed to kidney donations from the deceased. A decade ago, the rate for living kidney donations was much lower – about 25%."
At a Glance
Who – Dr. Amit Garg, Director of Lawson Health Research Institute's Kidney Clinical Research Unit at London Health Sciences Centre, Associate Professor, University of Western Ontario.
Issue – Multi-year waits for kidney donations from deceased donors mean more people are receiving "living kidney donations" from loved ones or friends. With the health criteria for donors becoming more relaxed, are there health risks for donors down the road?
Approach – Dr. Garg leads a team of investigators at 12 transplant centres across Canada that is monitoring the health status of 500 donors over the next five years.
Impact – Findings from the study will help guide health care providers in selecting donors and providing them with decision-making information and follow-up care.
At any given time, almost 3,000 Canadians are waiting for a compatible kidney to become available. Depending on where they live, the wait for a deceased donor kidney can range from four to seven years, says Dr. Garg, an Associate Professor at the University of Western Ontario.
During that time their health can deteriorate and their lives are constrained by the need for regular dialysis treatments. To ease the situation, many friends and family members are volunteering to undergo major surgery and live the rest of their lives with a key-hole-sized laparoscopic scar and one less kidney.
"In the most common scenario the donor is someone emotionally connected to the recipient – a parent, sibling or child. Or it's a very close friend or a spouse," says Dr. Garg. "But then there are paired exchanges, a new practice in Canada. That's where, for example, I can't give my kidney to my brother for compatibility reasons, but I give it to someone else and their donor gives a kidney to my brother. So we're swapping kidneys."
The most famous Canadian kidney swap was a quadruple paired exchange in June of 2009, when four people in Edmonton, Toronto and Vancouver received healthy kidneys from four donors they did not know.
For a person with kidney disease, the benefits of a transplant are obvious: there is a large survival advantage to having a kidney transplant versus dialysis and they can enjoy a far better quality of life. But what about the donors? After the glow of their altruistic act fades, what's life like with one kidney?
Studies have shown that most kidney donors have gone on to live long and healthy lives, a finding that Dr. Garg says is not surprising given that, until now, a rigorous selection process ensured those approved were "some of the healthiest people on the planet." But that could change as more and more people get the go-ahead to donate kidneys to meet the demand and shorten the long wait.
"Our criteria for accepting donors are more relaxed," says Dr. Garg. "We are allowing people who, before, we never would have considered. So we have an obligation to make sure that they stay in good health."
To that end, Dr. Garg is leading the largest-ever ongoing study of life after kidney donation. Funded by the Canadian Institutes of Health Research, he and colleagues at 11 other transplant centres across Canada will monitor the health of about 500 kidney donors – comparing them to 500 non-donors – to see how they fare.
Because the kidneys regulate how the body processes salt and water, there is some concern that donors could be more susceptible to blood pressure problems down the road, says Dr. Garg.
"Two studies have come up in the past year highlighting that young women who become donors and later become pregnant may have difficulties with high blood pressure during pregnancy. Again, it still seems safe, but the risk does seem higher."
Other studies have suggested that the occasional kidney donor, after the excitement of making the donation and going through the operation – a low-risk procedure with a 3-in-10,000 mortality rate – can slip into a depression.
"It's rare," says Dr. Garg. "As part of the study, we're trying to identify who is at risk, who demonstrates these things, so that we can mediate that as much as possible through our selection process."
The results of the study will help doctors present all the possible risks to potential donors so they can make their decision, which is often an emotionally charged one, with a clear idea of what they are getting into. It will also guide physicians as they provide follow-up care for kidney donors.
"Also something to consider is that we need the consent of two people in this process, the donor and the recipient. The donor often makes the emotional decision and is almost always willing to donate. But the recipient is also very interested in knowing what the implications are for their loved one," says Dr. Garg. "This (study) will also provide them the information they need."
Kidney Transplants, by the numbers:
- According to Dr. Garg, there are about 100,000 Canadians living with kidney disease.
- At any given time, almost 3,000 of them are waiting for kidney donations.
- In many parts of Canada, people wait for a "deceased" kidney an average of 4 to 7 years.
- There are about 1,200 kidney transplants performed in Canada every year.
- Roughly 500, or 40%, of those transplants are "live kidney donor" transplants, usually from family members, spouses or close friends.
"It's our obligation to ensure that patients have all the right information before making this important decision."
"I had no idea"
An Ontario man who donated a kidney to his adult son found reassurance in the rigorous pre-transplantation testing.
For Lou LaPlante, a 55-year-old retired autoworker who lives in Windsor, Ontario, the most difficult stage in donating a kidney was the initial uncertainty.
Jason, one of his two sons, found out four years ago through a regular medical checkup that he had only 15% kidney function. It was a shock – the then-28-year-old's only symptom was fatigue. Within months his skin had a yellowish tinge from jaundice and he was taking four-hour dialysis treatments three days a week.
"I said, 'Don't worry, I'll donate a kidney.' That was the immediate response," says Mr. LaPlante. "But I had no idea what was involved. I never considered all the health implications. Once you're informed about everything and it's explained to you, it gets better."
Mr. LaPlante found reassurance in the rigorous tests he underwent at the London Health Sciences Centre.
"They sent me for all kinds of tests – stress tests, blood tests, everything you can think of. As we got more and more into it, the more tests I did, the more I discovered how healthy I was. I wasn't worried. My wife felt more at ease."
The transplant went ahead in March of 2007. Mr. LaPlante had a mild complication – a bout of pneumonia – but was only in hospital in London for three days before spending three months recuperating at home. He returned to work in August, and then retired in December.
Jason made a full recovery and has resumed working. He and his wife had their first child a year-and-a-half ago and are expecting a second in December.
"I'm glad I was able to do it," says Mr. LaPlante. "My son's health is perfect."
His own health is also very good, although he is now on a mild medication after his blood pressure crept up slightly.
"When you have one kidney the worst thing you can do is subject it to high blood pressure. So they put me on the lowest level of blood pressure medication. I've been on it for about a year now and it's bang on."
The LaPlante Family
Top left to right: Jason, Jason's brother Walter, Lou
Bottom left to right: Jason's wife Catherine, Lou's wife Pamela