Tag Archives: blood

Jumping Through More Hoops

Yesterday, Monday, July 25, was round two in my series of appointments in anticipation of my kidney transplant surgery on Friday, July 29.

As University Hospital is, as the name indicates, a teaching hospital, I have been asked to be involved in a research project. We’ve probably all heard about the good bacteria in our gut, routinely promoted in yogurt commercials. This research project will investigate the impact of a transplanted kidney, with its own bacteria, into the transplanted person’s gut.

Good-Vs.-Bad-Bacteria

This research project of course meant more blood work, so I once again had blood taken from me. And once again, the bloodletting started in one hand and finished in the other. After a couple of hours in the air conditioned hospital, my veins were not terribly accessible. One nurse saw me coming in and said that she was happy that she was busy at the time, thinking that she would therefore not be the person to attempt to draw my blood. However, by the time the requisition was processed, she turned out to be the lucky one, and got the first crack at me. To quote another nurse, I’m a “nice enough person,” but I guess drawing blood from me doesn’t often happen very easily.

It's a joke! The women who take my blood are always kind to me!

It’s a joke! The women who take my blood are always kind to me!

I heard that drawing blood will not be that difficult once the surgery is done. Speaking with a nurse in the living donor program, I learned that a “central line” will be established in my neck(!) which will allow blood to be drawn and meds to be injected without repeatedly poking me with a new needle. I have this image of myself as looking like some kind of Frankenstein’s monster. As long as they don’t have to bring me back from the dead, I’ll accept a bit of a monstrous look for a little while. In fact, I saw a young woman at the hospital a few weeks ago who was there for a post-transplant clinic appointment. She had been discharged from the transplant unit just the week before and looked not at all monstrous.

One of the most interesting and sensitive things that I learned about living kidney donation has to do with the confidentiality of the donor and the recipient. I have friends in British Columbia, known to me, who are willing to donate to me but who are incompatible blood types. One of them will therefore donate to someone in need locally but they will not know or meet that person. Likewise, I will not know or meet the person who donates to me. In fact, the hospital will take some pains to maintain confidentiality. For example, my family and the donor’s family will be in separate waiting rooms in the hospital. If discussing the surgery with anyone else during the day of the surgery, I will be undergoing the more generic “abdominal” surgery rather than transplant surgery.

So, what can I do to say thanks? I can write a letter. The social worker with whom I spoke suggests that I write a letter to the donor, keeping everything anonymous and without any personally identifying information. Then, with the social worker having my name and the date of the surgery, she can deliver the letter to the donor.

'Okay, Mom. I'm sorry I re-gifted one of the kidneys you gave me.'

‘Okay, Mom. I’m sorry I re-gifted one of the kidneys you gave me.’

This is actually a fascinating area, apparently. Apparently, some families of donors and recipients have chatted casually while getting coffee at the Tim Horton’s in the hospital and have almost inadvertently made connections. At other times, especially in the case of deceased donors, some recipients or their families have combed through the obituaries of area newspapers in efforts to identify their donors.

Finally, I want to mention the intended schedule. I have to be at the hospital at 6 AM on Friday morning. However, I won’t actually have my surgery begin until about 1 PM. I do have to be there early in the morning, though, because the surgeon will not begin operating on the donor until my health has been determined to be adequate for surgery that day. If I show up at 6 AM with a fever, they are not going to proceed. It’s going to be a long day.

'How's that kidney transplant going?... I need him back on the field - pronto!'

‘How’s that kidney transplant going?… I need him back on the field – pronto!’

Three days to go! Thanks for all your support.

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Hurry Up and Wait

That’s kind of how my day went yesterday. I went to bed early Sunday evening so that my full eight-hour dialysis session could be completed in time for me to make it the hospital according to my appointments.

As I think I’ve mentioned before, I live near the University Hospital, where London Health Sciences Centre’s Transplant Unit is located, so I walked there. My first appointment was scheduled for 7:30 AM, but I had to first register as an outpatient for the day, so that meant getting there at 7:15, which meant leaving the house at about 6:30 AM. Suffice it to say, in order to get out of the house on time, I got up while it was still dark.

The first stop was to cardiology, where two tests were run, an echocardiogram and an ECG (electrocardiogram). I don’t yet know about the results of the first test but the ECG was “normal,” which is good. (Unlike at Lake Wobegon, the goal is not to be “above average”).

KeepCalm

The next stop was to the lab to give some blood samples. I’ve been going to this same lab location at least monthly for the last two years for dialysis blood work so the nurses knew me and recognized the significance of me coming in for a different set of tests. The funny thing, though, was that, until now, they were having to draw blood out of the veins in my hands so as to “save the arm veins” for any potential need for hemodialysis in the future. Since, that seemed to no longer be a concern, we agreed she could take the blood out of my arm. Unfortunately, thanks to spending a great deal of time in the cool air-conditioned hospital, the veins in my arm were less accessible than usual and she couldn’t get to them. So, back to the hand vein. But, there were so many tubes to fill that the blood stopped coming in the one hand. Another nurse came over and they coaxed the last little bit out of my other hand. Thanks to an injection of gas into my arm earlier during the echocardiogram, I wound up with bandages on both arms and both hands! Another man in the lab was looking on at me somewhat aghast. When all was said and done, it wasn’t all that bad and I managed to leave under my own steam. No fainting, etc.

'I'm concerned about the high levels of blood we found in your blood test.'

‘I’m concerned about the high levels of blood we found in your blood test.’

bloodtest

Following a routine chest X-Ray, I done for the morning. In the afternoon, I had three appointments. The first was with the pharmacist who reviewed three anti-rejection drugs with me that I would most likely be prescribed. If you’ve ever seen those drug commercials that are on American TV channels, that extol the virtues of the drug before highlighting all the unwanted side effects, that is a little what this appointment felt like, minus all the beautiful scenery and marketing glitz. One of the positive pieces, though, is that likely a number of drugs I take now will be discontinued. On the negative side, the anti-rejection drugs will compromise my immune system somewhat, which will make me more susceptible to, among other things, skin cancers (although such skin cancers tend to be of the more treatable type), so I guess it’s good that I live in the snow belt and will be covered up for several months of the year.

My last appointment was with the surgeon who will do the transplant. He was very busy yesterday so I waited quite a while to see him, but I finally met Dr. Alp Sener. He came across as warm, personable, and very intelligent (that probably goes without saying for physicians who have a PhD and an MD). I was delighted to hear that, if the kidney is functioning well right after it is transplanted, that he would proceed to remove the peritoneal dialysis catheter during that surgery. Although peritoneal dialysis has maintained my health in a way that I could not have experienced otherwise, plugging this line that comes out of my body into a machine every night is not only a physical tethering; it feels symbolically like I am tied down and restricted.

AlpSener

Dr. Alp Sener

Having said that, it is a restriction worth putting up with, given the alternatives that were available to me. I remember that not everyone has the benefit of the kind of medical care that I am receiving, almost entirely paid by our taxes, so that we don’t have to choose between life and poverty. For those in different circumstances, such option may not even exist. It is a reminder to be grateful for the many gifts that I have, by virtue of living where I do.

My final appointment was to have been with the Transplant Unit’s Research department. In fact, it had gotten so late in the day that I simply forgot about it and went home. I had left home at 6:30 that morning, and didn’t get home until 5:30 that evening. It had been a long day. I have another series of appointments later next week, so I expect my meeting with Research can be rescheduled.

With all that walking and all those meetings, I slept very soundly last night, which has been rare for me since beginning dialysis.

I’ll conclude with the request that, if you have not yet registered as an organ donor, please go to this page, locate the link for your province, and take the very few minutes that it requires to become an organ donor. Thanks.

The Ineluctable Logic of the Paired Donation program

The Ineluctable Logic of the Paired Donation program

I have gone through three rounds in the Kidney Paired Donation (KPD) program, two of them teamed with two willing but incompatible donors. No match has been found for me. With some time on my hands, I began to think about the likelihood of a match being found. Based on blood type distribution alone, here is what I have realized.

First of all Rh (+/-) does not matter when it comes to organ transplants so I’m combining the Canadian statistics for Rh positive and negative factors into one:

Blood Type

O A B AB
Percentage 46 42 9

3

As you can see, Type O is the most common, followed closely by Type A.

Second, let’s take a look at which blood type can donate to which blood type:

Donor Type

O A B AB
Recipient Type O, A, B, AB A, AB B, AB

AB

On the donor side, note that Type O can donate to any recipient type. On the recipient side, note that AB can receive from any donor type. Note further that Type O can only receive from a Type O donor.

So, let’s put these statistics together and consider them in light of the fact that I am a potential Type O recipient and my friends are potential Type A donors.

On the face of it, it doesn’t look that bad. I can only receive a kidney from a Type O donor but that is the largest blood group so I have a relatively large pool to draw from. Furthermore, my potential donors are from the second-largest blood group so you would think that there would be substantial demand for a kidney donor with Type A blood. The paired donation program should work well.

That is not the case, however. Let’s imagine that someone with Type A blood needs a kidney transplant. She makes it known to her friends and relatives. Since she can receive a transplant from a Type O or a Type A donor, she can draw on 86% of the population. Consequently, it is less likely that she will need to enter the KPD program. There is therefore relatively little demand for Type A donors (my two friends) within the KPD program. The possibilities for an exchange seem less likely.

Now consider someone with Type O blood who needs a kidney transplant (me). He can only receive a transplant from a Type O donor. But let us further consider that the Type O donor can donate an organ to any blood type. A type O donor, if he becomes aware of a friend or relative who needs a kidney, can donate to that person directly, irrespective of the recipient’s blood type, so there is no need to enter the KPD program in order for the friend to receive a compatible kidney transplant. There is therefore relatively little supply of Type O donors in the KPD program.

The ineluctable (always wanted an occasion to use that word) logic of the KPD program is that my situation of being a potential Type O recipient, even with two potential Type A donors, means that the chances of a match on the basis of blood type alone are vanishingly small.

The Saving Grace

However, there are in fact Type O potential recipients who have been matched in the KPD program. The saving grace, if that is the right term, is that blood type is not the sole determinant of compatibility. We carry antibodies within us and these antibodies complicate the matching process. A potential recipient might carry antibodies that will attack the otherwise compatible Type O kidney were it to be transplanted into a given person. For that reason, there are potential Type O donors and potential Type A recipients in the KPD program, and enrolling in the program is not a hopeless or lost cause. It just means that I may have to stretch out my expectations when it comes to how quickly a match will be found.

Is there something that can be done about this? Well, I am not one to approach others directly to ask to have themselves tested as possible living donors, but if you have not yet done so, please register as an organ donor. We are, after all, mortal beings, and once we are dead, we have no more need for our organs. Consider such registration a basic part of your will and estate planning, and consider as well, that you have within you the potential to save up to eight lives. Isn’t that a legacy worth leaving?

Links:

For the Kidney Paired Donation program:

https://www.blood.ca/en/organs-tissues/becoming-live-kidney-donor

To register as an organ donor upon your death (select the link to your province):

http://www.cantransplant.ca/home/organ-and-tissue-donation-consent/

 

The Waiting is Over…For Now

Thanks for all your words of support and prayers on my behalf. I just got the news today that the Living Donor Paired Exchange (LDPE) program did not come up with a match for me this time. Assuming we remain eligible, both I and my incompatible donor will be part of the matching run during the next quarter.

There are two other alternatives:

1. Someone who is compatible with me could step forward and offer to donate a kidney directly to me.

2. A deceased donor could be a match for me. I remain on the deceased donor waiting list even while the LDPE program continues to try to make a match for me and all the others who are in need of a kidney transplant.

In the meantime, I continue with nightly peritoneal dialysis, which is hardly the worst thing in the world….

Might I suggest that, if you haven’t done so already, please sign up as an organ and tissue donor according to the protocols in your particular province. In Ontario, go to beadonor.ca to register or confirm your status. Don’t assume that something you did when you last updated your driver’s licence is still valid. Almost all provinces have moved to an online registration system. It only takes two minutes to register.

The ethnic angle on who donates organs — and blood

I am reblogging an article, “The ethnic angle on who donates organs — and blood,” from the always-worth-reading Douglas Todd, writer on spirituality, ethics, migration and ethnic diversity for the Vancouver Sun. The article, published in July of this year, focusses on the lower mainland of British Columbia, but also makes reference to an article that Todd wrote back in 2005. One wonders about how things are different (or the same) in present-day Ontario or even in the regional centre of London:

http://blogs.vancouversun.com/2014/07/02/the-ethnic-angle-on-who-donates-organs-and-blood-in-canada/