How Does Living Organ Donation Work? with Dr. Joseph Del Pizzo and Steve Wilson

Episode Transcript

Angelique: Welcome to Health Matters, your weekly dose of the latest in health and wellness from New York Presbyterian. I’m Angelique Serrano.

This April, we’re honoring National Donate Life Month with a very special conversation between a living organ donor and his surgeon. Today, Steve Wilson shares his donor journey, from what motivated him to donate his kidney to a stranger to what his surgery and recovery were like. Spoiler alert: He summited Mount Kilimanjaro just two years after his organ donation.

His doctor, transplant surgeon Dr. Joseph Del Pizzo at NewYork-Presbyterian and Weill Cornell Medicine, also shares his insights into the minimally invasive procedure for kidney transplants and why it’s so crucial to have organ donors like Steve give the gift of life.

Angelique: Steve and Dr. Del Pizzo, we’re so thrilled you were both able to join us today for a conversation about what it’s really like to be a living organ donor. So thank you. 

Steve Wilson: Thank you. 

Dr. Del Pizzo: Thanks for having both of us,

Angelique: I imagine while some people might know facts about organ donation, fewer people might have the opportunity to actually ask someone directly, “Hey, what’s that like to donate an organ?”

Dr. Del Pizzo: I think it’s really interesting to get two different perspectives about what it’s like to be a kidney donor. Not only from the surgeon who typically will do the operation, prepare the patient for the operation and what to expect before, during and after the surgery, but more importantly to get the patient’s perspective because everybody has a different experience. It wouldn’t be possible without the support of Weill Cornell Medicine and the transplant department and division, but most importantly, without people like Steve Wilson.

Angelique: Thank you, Dr. Del Pizzo. And you’re so right. Having both of your perspectives today, it’s very special. Steve, why don’t you tell us a little bit about yourself?

Steve Wilson: Sure, I’m a financial planner from Westchester, New York. I donated my kidney when I was 53 years old, I’m now 57. There’s been absolutely no change to my life at all. I was active before donating a kidney. I’m active after donating a kidney. If I could do it again or do it every six months, I happily would. I never have met my recipient and that’s perfectly okay. I know that I gave somebody the gift of life.

Angelique: Absolutely. So, Dr. Del Pizzo, I wondered if you could tell us a bit about what living organ donation is. 

Dr. Del Pizzo: Sure. Living organ donation is when a living person donates an organ or part of an organ to someone in need . And that person can donate an organ to someone they know, someone they don’t know, someone they’re related to, someone they’re not related to. There are a lot of options.

But living organ donation is very important. I can focus on kidney donation because that’s what I’m involved in. In the United States, there’s hundreds of thousands of patients that are either suffering from end stage kidney disease, maybe on dialysis that are in need of a kidney transplant, and the need for transplantable organs is really critical.

The number of deceased donors available cannot meet the need for people that need organs. So living kidney donation has become just critical in helping patients in need.

Angelique: Absolutely. And Steve, were you aware of living organ donation before you came to your decision?

Steve Wilson: So I did have some awareness with it. My cousin gave his kidney to his wife. And I’m like, that’s just the coolest thing I’ve ever heard to give your kidney to your wife. It’s really cool. And I was like, you know what? I would like to do that. Just, you know, you can give of your time, you can give of your money, but to truly give of yourself to save another person’s life, particularly when there’s no detriment to your own, other than a couple of weeks of discomfort. I was happy to do it. So that was really how it all came to be. 

Angelique: That’s remarkable. So what were those next steps that you took once you realized, this is something I want to do. What did you do next to make it happen?

Steve Wilson: I came across a post of a high school friend who, her daughter had just received a kidney. And I called the hospital and I said, “what would be the steps if I wanted to donate a kidney?” And they told me what those steps would be. You go give blood, if you’re relatively healthy enough, then you go in for a full day evaluation. Then I was told, yes, you’re healthy enough to donate. 

Angelique: Mm hmm.

Steve Wilson: I said, okay, I’ll finish the triathlon and I’ll donate after that. So I did the triathlon with my son in November of 2019. And in January of 2020, the hospital called and said, we have a potential recipient. Are you ready to go? And I was ready to go and I donated February 6th of 2020.

Angelique: Wow. Incredible. So you are always athletic.

Steve Wilson: That’s a stretch, Angelique, but I’m active. I like to go for  ultra long bike rides, you know, 75 or a hundred miles. 

Angelique: That sounds athletic to me. And Dr. Del Pizzo, when someone is willing to donate a kidney, what are those steps like from your perspective?

Dr. Del Pizzo: First of all, it’s an extensive process. It’s important to realize that the prospective donor undergoes the most comprehensive medical and social evaluation of their life to really identify potential short term and long term risks to donation for that specific donor.

Angelique: Mm hmm

Dr. Del Pizzo: It’s really about educating the donor about the process and the surgery, and really to confirm that being a living kidney donor fits into his or her life. This is how you might feel before, during, and after the surgery. So a lot of boxes have to be checked in the initial process. That includes meeting with a social worker and a psychiatrist. 

And we have something called an independent donor advocate team. So this is a team, made up of coordinators and doctors who are completely separate from the recipient surgery team. And their main directive is to assist the donor through the process, but more importantly to protect and promote the best interests of the donor, advocating for the rights of the potential donor — insurance issues, life issues, time away from work and childcare commitments and all the things that we all have every day in our life that we may not think about when we’re going to come forward to give the gift of life in this instance, you know, kidney donation.

Once that is done they go through what Steve kind of referenced which is the compatibility profile and compatibility is a word that gets thrown around a lot in the living donor process because the donor has to be compatible with the recipient. I don’t mean personality wise, I mean blood type, antigens, and things like that to make sure that there’s not gonna be a high chance of a rejection. Once they’re through that process, then they start to meet with the radiologist to get a CAT scan to look at anatomy and to provide us with information that will help us perform the surgery safely, not only for the donor, but to procure a kidney that’s going to work well in the recipient, hopefully immediately. 

Then the donor will meet me as the surgeon pretty much last, you know, maybe a week before the procedure, because my main role in this is to, guide the patient through the surgical process safely, to make sure they’re informed about the procedure, and then in the immediate postoperative period to make sure they’re recovering in an ideal fashion. 

And by the time I meet the donor, I know that he or she is in great health, has an altruistic reason for donating, and should not have any long term effects of donating his or her kidney. If they don’t pass those aspects of the screening process, I never meet the donor because they’re ruled out before that.

Angelique: It’s really great to hear that there are so many checks and balances in the process to make sure that the donor feels supported and ready to do this. Steve, I’m curious, what were some questions you had as you were moving through the process? 

Steve Wilson: I think my main questions were, how much will this impact me over the long term? I wanted to be able to do another Ironman and just remain active. And, all the people, including Dr. Del Pizzo said there’ll be no long term impacts. And in fact, I think the statistics show that people with one kidney live longer than people with two kidneys, not because they have one kidney, but in order to donate, you have to be pretty healthy. And the other kidney just picks up the function, so you’re not losing anything by donating.

Dr. Del Pizzo: I was just thinking a lot of living donors, Steve included, if I remember, don’t have a lot of questions for me by the time I meet them because they’ve undergone the process for so long and have had the questions answered already by our donor team that prepares them for the meeting with me.

They may have a few questions about the surgery and their incision but most of them don’t have a lot of questions because they’ve made up their mind already.

Angelique: Well, let’s talk a bit about the procedure. Dr. Del Pizzo, can you share a bit about what the process is like?

Dr. Del Pizzo: The kidney donor surgery has evolved a great deal since it started. And the first kidney, live kidney donation was done in Boston in 1954 between identical twin brothers. This was before immunosuppression and steroid treatments where you had to be genetically identical to the person to give the organ. In the old days, you would literally have to have a large open incision to have your kidney removed.

You know, one of the reasons why you don’t hear about people injuring their kidneys in an accident or playing sports is because our kidneys are very well protected behind our rib cage and our back muscles, and that’s great for not harming your kidney, but it makes the surgeon’s job very difficult to try to remove it.

And in the mid to late nineties, the laparoscopic approach for kidney surgery was developed and that really revolutionized the living kidney donation because patients were given the opportunity to help someone, but then had a smaller incision, a shorter hospital stay, a quicker recovery, and most importantly, a shortened interval to getting back to their life, whatever their obligations were, you know, we call it back to 100 percent from before the surgery.

We helped to pioneer optimization of the laparoscopic approach where we now are able to do the surgery through just one small little incision in and around the belly button. It’s about a three inch incision, very small, very quick to heal from. Through that incision, we insufflate the abdominal cavity with carbon dioxide, which will expand it and give us room within the abdominal cavity to do the surgery. The organs kind of separate from one another. And then we’re able to do the surgery through that one incision.

It takes about an hour and a half or so to do the surgery. And then, once completed, the patient is in the hospital for one or two nights on average. And usually by four weeks after the surgery, they’re not only back to work, but their exercise routine, and all the things that they were doing prior to the surgery.

Angelique: It’s incredible to hear how far the procedure has come in such a short amount of time. Steve, how was your recovery? You mentioned that you felt pretty good pretty soon after.

Steve Wilson: Yeah, there’s no way my incision is close to three inches. It’s more like two millimeters. I mean you cannot see my incision, there’s just no visual scar at all. I was back on my exercise bicycle indoors two weeks to the day after surgery and back at work. I had my first in person meeting one week to the day after surgery and I spent one night in the hospital. The surgery was remarkable how uninvasive it seemed to be.

Angelique: Well, I think I know that you embarked on some pretty amazing adventures after this procedure. 

Steve Wilson: Myself and 21 other kidney donors, we climbed Kilimanjaro in 2022 and we summited the mountain on World Kidney Day. It was a lot of fun. And a second group did it this World Kidney Day. They just summited and that may become an annual thing with an organization known as Kidney Donor Athletes, KDA. 

Angelique: That is incredible. I’d love to ask you both, are there any misconceptions that you would love to clarify about this process, about living organ donation?

Steve Wilson: Well, I think one of the main misconceptions is people don’t even realize it’s a thing. We all know it because we do what we do in the community, but many people don’t realize you can donate a kidney or a liver or to somebody else, a part of a liver. And then I think another misconception is people think they are now going to be disabled or debilitated for the balance of their life if they do this and they just don’t realize that it’s not going to change their life at all.

Dr. Del Pizzo: He’s exactly right. The patient comes in, really doesn’t have any misconceptions. He or she has done their research, spoken to our independent donor advocate team, and is very well versed in the process and the minimal long term risk.

A lot of times it’s their family members who have to be educated and put at ease because they’re concerned about their loved one donating a kidney to a stranger. You don’t know this person. Why, why are you doing this? And, you know, other than he or she is an extremely good person and wants to do good for somebody. I think the other thing is the misconception is how many people actually get help from a single organ transplant. It’s not only the person getting the kidney, but it’s everyone, you know, moving up on the list who’s not as fortunate.

Angelique: Steve, if you knew that there were some people out there listening right now who were thinking about it, what would you say to them?

Steve Wilson: I would say do your research. So I’m a mentor with an organization called National Kidney Donation Organization. And we mentor a lot of potential donors who plan on going through the National Kidney Registry, the NKR, to donate. You know, I never say to somebody, yes, go donate a kidney. I will share with you my experience. I’ll tell you the pros, if there are any cons, I can share with you. I think that’s the key, doing your own research and knowing the reasons why you’re doing it.

Angelique: That’s absolutely great advice, and I cannot thank you both enough for sharing your perspectives and your experiences. Thank you both so much.

Steve Wilson: Thank you. 

Dr. Del Pizzo: Thank you. Steve, always a pleasure.

Steve Wilson: Doc, be well, my friend.

Dr. Del Pizzo: You too.

 

Angelique: Our many thanks to Steve Wilson and Dr. Joseph Del Pizzo

I’m Angelique Serrano.

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Dr. Del Pizzo: Steve, when you make it to the top of Everest, I want a picture.

Steve Wilson: Not my thing. I’m never going.

Dr. Del Pizzo: Well, alright, we just figured out what his limitation is, he can’t climb Mount Everest.

Steve Wilson: I just have no interest. So, I am training for the Lake Placid Ironman though, so…

Dr. Del Pizzo: That’ll have to do I guess.