Allowing Altruistic Donors to be Altruistic

If you were embarking on a
search to find and interview the healthiest individuals on the planet, speaking
with kidney donors would be a great place to begin. People who have donated one
of their kidneys share many traits in common. They have incredible compassion,
mental strength, and are willing to undergo a major operation that carries a
rare (but not zero percent) risk of complications to benefit a friend, a family
member, or in some cases, a complete stranger. But even all these traits do not
qualify a person to become a kidney donor.

As nephrologists,
our duty in evaluating prospective kidney donors is to identify any potential
health problems that may put the donor in harm’s way. A prospective donor that
is too young may not have accumulated the chance to develop certain diseases,
making donation risky. A donor that is too old may carry excessive surgical
risks, making the donation procedure unsafe. An intensive search for malignancy
and transmissible diseases is required because of the risk to the donor and the
potential recipient. Any history of kidney problems, including
microalbuminuria, proteinura, a family history of kidney disease, and recurrent
kidney stones, precludes kidney donation. A myriad of other considerations are
also made by the transplant team, including a careful psychiatric evaluation of
the donor and a number of blood tests, evaluating for ABO compatibility and HLA
matching, which lead to possibilities of direct donation, paired exchange, or
transplant chains outlined in this blog post.



Unfortunately,
there is one risk whose occurrence is difficult to predict and whose impact is
impossible to quantify: loss of health insurance. Described in this New York
times article is the case of a father who donated his kidney to his
daughter who had lost her renal function in the face of lupus nephritis. While
he gained the chance to make an impact in his daughter’s life, he lost his
health and life insurance despite appeals from his nephrologist stating that
his remaining kidney was healthy.



The Affordable Care
Act recently upheld by the Supreme Court will protect people from being denied
health insurance because of pre-existing conditions beginning in 2014. However,
it will not prevent insurance companies from raising premiums on patients they
consider higher risk, which may include kidney donors despite numerous
prospective studies with long-term follow-up attesting to the safety of
undergoing a uninephrectomy.



It is not clear how
we can accurately assess the risk of insurance loss or rise in premiums for prospective
donors, but one thing is clear. We need to allow altruistic donors to be
altruistic.

Posted by Karandeep Singh