Dear Dr. Roach: I am a female, mid-50s in very good health. I’m considering donating a kidney to a friend’s adult son, who has been on dialysis for several months.
I’ve read quite a bit about it, but can you give me your concerns as if I were your good friend? I understand that any surgery can be risky, but it seems like a wonderful way to help someone, using an organ that my body won’t miss and I feel that I really want to help.
P.D.
It is wisely said that “generous deeds should not be checked by cold counsel,” but were you my good friend, I would still feel the need to tell you the risks of donating a kidney.
Removing a kidney is not a trivial operation, and as you say, any operation has risks. The overall risk of death from a kidney donation is about 1 in 3,000 people in the first 90 days after surgery. Any major surgery has additional risks, including bleeding, infection, blood clots and pneumonia; however, these risks are relatively small and your being in very good health is a good sign that your risk is low.
People who have only one kidney are at slightly higher risk of developing kidney disease themselves. That increased risk is estimated to be between 1 in 200 people to 1 in 400 people. Donors also are at higher risk for developing high blood pressure and gout, but again, the risk is small.
You also are likely to have financial costs — even if you don’t have to pay out of pocket for the procedure, you may be paying for transportation, accommodation or suffer lost income or vacation time. Still, most people who choose to donate an organ do not regret their decision, although some note anxiety or depression, especially if the donated organ fails.
The risks, then, are pretty small, but not zero. You have to balance that against the benefit of helping someone get off dialysis. It’s not just a better lifestyle for your friend’s son: Transplantation dramatically improves life expectancy, roughly cutting death rates in half.
Dear Dr. Roach: I am scheduled for a cardiac catheterization and possible stent. My doctor is an assistant professor of medicine and is having a medical student assist him, which concerns me. I am worried that the student may affect the quality of care I receive.
G.M.
I think many people are concerned that being cared for in a teaching hospital may involve a trainee who is not yet fully qualified. People naturally want to be cared for by the most skilled person available.
I can reassure you that in my seven years of training and during my 25 years as a teacher of medicine in academic centres that students do not perform a procedure such as a cardiac catheterization. A student in a procedure like that will be observing. During surgeries, a student might hold a retractor to allow the surgeon to see better. Residents (after graduation from medical school) and fellows (after completing residency) gradually assume greater levels of responsibility after being directly observed by their professors and attending physicians. The quality of care in a training hospital is at least as good as the care in non-teaching hospitals.
Nonetheless, you do have the right to not have a trainee present for or assisting with your care. I hope you allow the student to observe and assist. Medical training and education is important and requires patients to be willing participants.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.
