Live Donor Kidney Transplantation with Lori Brigham and Jimmy Light, M.D., F.A.C.S.

Last Editorial Review: 10/23/2003

WebMD Live Events Transcript

Join Lori Bringham, executive Director of the Washington Regional Transplant Consortium and Dr Jimmy Light, Surgeon and Director of Transplantation Services at Washington Hospital Center, Washington, DC to discuss live donor kidney transplantations.

Event Date: 03/15/2000

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Welcome to the Women's Health Place Program on WebMD Live. Our guests today are Lori Brigham, executive director of the Washington Regional Transplant Consortium, and Jimmy Light, MD, surgeon and director of transplantation services at Washington Hospital Center in Washington, DC.

Lori Brigham, executive director of the Washington Regional Transplant Consortium, has been with the consortium since its inception in 1987. She is active in the organ procurement and the transplantation community, both locally and nationally. Brigham has served on the Organ Procurement Committee for the United Network of Organ Sharing, is a former board member of the American Share Foundation, and has served on a variety of committees and advisory panels for the North American Transplant Coordinator Organization and the Association of Organ Procurement (AOPO). Brigham currently serves on the Professional Advisory Board of the National Kidney Foundation of the National Capital Area and is Co-Chairperson of the AOPO Performance Standards Committee.

Jimmy Light, MD, is a distinguished surgeon and leader in kidney and pancreas transplantation. He is director of transplantation services at Washington Hospital Center in Washington, D.C. and an attending physician at both Children's Hospital National Medical Center and National Rehabilitation Hospital. He holds an academic appointment as professor of surgery and chief of the division of transplantation for the Uniformed Services University of the Health Sciences. Dr. Light is currently on the Board of Directors of the National Kidney Foundation of the National Capital Area, Chairman of the Transplantation Subcommittee of the Mid-Atlantic Renal Coalition, Scientific Advisory Board member of the Society of Organ Sharing, president of the South-Eastern Organ Procurement Foundation, and chairman of the Organ Medical Advisory Committee of the Washington Regional Transplant Consortium.

Greetings and welcome. Please feel free to ask Lori Brigham and Dr. Jimmy Light your questions at any time. Please preface your question with /ask. EXAMPLE: /ask What is the topic?

We will begin our discussion about Live Donor Kidney Transplantation in about 45 minutes. Did any of you catch the surgery on WebMD Live earlier today? We have scheduled this discussion as a follow up.

Welcome to WebMD Live, Lori Brigham and Dr. Light, it is a pleasure having you here this evening.

Brigham: Good evening.

Dr. Light: Nice being here. 

Moderator: Apologies everyone, my system is a little bit slow this evening. Even moderators can have computer issues! Perhaps we could begin with an overview of a hand assisted, laparoscopic nephrectomy ... Dr. Light could you give a brief explanation of this procedure please?

Dr. Light: Yes. This is a minimally invasive procedure to remove the kidney for transplantation, where the hand is inserted into the abdomen thru a small incision to assist with the laparoscopic instruments.... some feel it makes the procedure easier than doing it by only instruments. The advantage of this approach is that the pain of surgery is less and the patients recover faster than when the kidney is removed by standard open surgery techniques... It is controversial whether the hand assisted procedure is better than the approach pioneered by Ratner in Baltimore. 

ladyg2_WebMD:What is done to prepare a live donor?

Moderator: Dr. Light?

Dr. Light: Donors, of course, must be in good health and have normal kidney function and be compatible immunologically with the recipient, and have normal vascular anatomy to the kidney. Except for that, nothing special except for preoperative hydration to insure optimal kidney function during the removal procedure. 

Ellafit_WebMD: If I am interested in becoming a donor, what do I need to do?

Moderator: Lori, could you address this one please?

Brigham: Are you interested in being a living unrelated kidney [donor], or donating your organs and tissues when you die? I can address both.

Moderator: Please, that would be great.

Brigham: Let's start with cadaveric donation. If you want to donate organs and tissues when you die ...TELL YOUR LEGAL NEXT OF KIN. Let them your know your desire to donate upon your death.  At the time of your death, we will work with your legal next of kin and the hospital to evaluate your medical suitability to be a donor. What ever is possible for you to donate, we will discuss with your family.  It is important that you share your decision so that they can ensure that your wishes are carried out. There are many options for donation. Organ, tissue, and both are needed for transplantation and research, so please consider both. Now to be a living unrelated kidney donor, the Washington Regional Transplant Consortium (WRTC) has recently started a living donor registry program for people just like you. At this time, all you would have to do is contact our office and leave me your name, telephone number and an address.

Moderator: Can folks do that via your website?

Brigham: They can certainly visit our web site, but I would encourage them to call 703-641-0100 and talk with me directly. To be a living donor of a kidney, you must be carefully medically screened and you also have to undergo a psychological consult to ensure that you understand any risks involved and that you are capable of making decisions.

Brigham: Once all the screening is accomplished and you are accepted, we will run the current UNOS list and determine the best suitable match for your kidney. Then the surgeon will make all decisions regarding accepting your kidney for transplant. 

Goose39_Lycos:Is there an age limit on organ donation?

Brigham: For cadaveric donation, not really. From 1 day old on up ...the oldest donor was a liver donor at 87. We consider each case individually and on a case by case basis. There are a whole lot of people at 70 that are very healthy and active and thus can potentially donate, some even healthier than people at 50 years of age. Recipients are also older now so we don't give any age restrictions.

For living donors, not really. We just performed a spouse transplant between 71 year olds and they have done well. The key point is physiological age, the recipient's need for kidney mass, and the donor's residual kidney function. If there is enough to share and it's in good shape, then donation is good.

Ellafit_WebMD: Dr. Light, what is the average success rate of kidney transplants from live donors done with this procedure?

Dr. Light: The success rate is the same as for LD's from the open procedure, viz over 95%. There should be no difference in either renal function or outcomes if both are performed well.

ladyg2_WebMD: How do surgeons choose the left or the right kidney?

Dr. Light: Generally, we prefer the left kidney because the vein is longer and the technical aspects of the surgery as less complicated. Some surgeons do remove the right kidney by the lap technique. We do not recommend that approach.

smersh_WebMD: Why is the non-functioning kidney left in the patient sometimes?

Dr. Light: Do you mean the recipient?

smersh_WebMD:Yes -- that's what I've heard...

Dr. Light: We learned about 20 years or so ago that pretransplant removal did not influence transplant outcome... so there are very few indications to remove the native nonfunctioning kidneys.

ladyg2_WebMD:What is the average wait for a kidney?

Moderator: Lori - would you like to address this question?

Brigham: It varies by different parts of the country but, in general, 2 years and up. Also it depends if you have been pre-exposed to human antigen and if you have developed antibodies to human antigen. If you have developed these antibodies to human antigen, you will be harder to find a kidney that your body will accept.  The incredible wait for organs, especially kidneys, is why we encourage everyone to consider donating your organs and tissues when you die.

Dr. Light: If you consider there are nearly 50,000 people waiting for kidneys, and 5,000 to 6,000 donors giving 2 kidneys each; the math works out to be about 4 years on average. For some a great deal longer and for some a little shorter, but in reality too long for everyone. That's why many of us are such staunch advocates for living donation, and are strongly encouraged. Laparoscopic donation makes the process much easier for the donor, whether it is hand assisted or by standard laparocopic technique.

Moderator: What is the recovery time for a donor?

Dr. Light: By the technique shown today, most donors resume normal activities within two weeks. By the older, traditional open nephrectomy, it's more like 4-6 weeks.

Ellafit_WebMD:What is the testing process to see if a family member is a fit for transplant?

Moderator: We are nearing the end of our discussion with Lori Brigham and Dr. Jimmy Light. Please ask your final questions at this time. Please preface your questions with /ask.

Moderator: Dr. Light, would you like to address that last question?

Dr. Light: Do you donor or recipient?

Ellafit_WebMD:donor

Dr. Light: Sorry can't type either. I meant to say do you mean donor or recipient? Since I have not heard back, the best answer is to contact your local transplant center especially for recipient evaluation. The donor issue was mentioned earlier in the hour. The entire idea of testing for the donor is to ensure that the donation will not in anyway impact your health, short term or long term. Each transplant center has similar testing procedures but if you are considering donating to a family member, you will want to contact their transplant center to determine the testing requirements.

kandu__WebMD:Is there a limit on how many transplants a patient can have?

Brigham: Not by National Criteria. It depends on your health and would be a decision made in conjunction with your transplant surgeon. On the other hand, if you needed a second transplant because you didn't take care of the first with proper medication and compliance with your physician's instructions, then they would evaluate carefully if you were medically suitable to receive another organ.

Moderator: Dr. Light, do you have anything to add?

Dr. Light: Not really. It does become more challenging immunologically to find a match, and more challenging technically to make the kidney fit. Then there's the issue of where is the kidney coming from, and the fairness of reallocation when so many are waiting. Having said that, my personal record is 5 and that last is still working nearly 20 years later.

kandu__WebMD:Can a kidney transplant recipient donate their organs and tissues?

Brigham: Yes, of course, it is considered on a case by case basis and depends on their health status when they die. Retransplantation of the donated organ has not worked out very well in general; other organs and tissues can be donated if the tests and conditions are appropriate.

Goose39_Lycos:Could a daughter donate to a father?

Brigham: Yes.

Dr. Light: Yes, donation from offspring to parents is possible...and the outcomes are more successful than those with a cadaveric donor. I encourage a "family solution " to the "family problem."

Moderator: Lori Brigham and Dr. Jimmy Light, thank you very much for joining us for this important discussion. It was a pleasure having you here today.

Brigham: Great to be here. Feel free to sign on to our web site at www.wrtc.org for more info on organ and tissue donation.

Moderator: I hope you will consider returning to WebMD Live to talk with our Members again, we would love to have you back

Dr. Light: Bye.

Brigham: Bye.

Moderator: Many many thanks to both of you, GOODNIGHT. 

For those of you who watched the hand assisted, laparascopic nephrectomy surgery earlier today, both sisters, donor and patient, are doing well. We will have the webcast of the surgery archived on the site under Live event archives in a week or so for you to access at your convenience.

Please check out our member to member message boards for more information on kidney transplants...talk with other members.

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Last Editorial Review: 10/23/2003