Scott Ball / Rivard Report
When Chané Gildon, a 40-year-old from Odessa, learned none of her family members were a match for the kidney transplant she desperately needed, she broke the disappointing news to her best friend. Stephenie Gardiner listened, then decided to find out if she could be a match.
Last December, Gildon underwent the transplant at Methodist Specialty and Transplant Hospital, receiving Gardiner’s kidney. It was the hospital’s 200th live-donor kidney transplant of 2016 and marked the most such kidney transplants ever completed in a single year at a transplant center in the United States, according to hospital officials.
“People asked me how I could donate a kidney,” said Gardiner, 36, a mother of three from Jefferson City, Mo. “I couldn’t stand to see Chané growing weaker and suffering. I don’t understand how anyone wouldn’t do this for someone, if they could.”
Dr. Adam Bingaman, head of the live-donor kidney transplant program, joined the Texas Transplant Institute at Methodist Specialty and Transplant Hospital in 2007 and became the Director of Abdominal Organ Transplantation in 2012.
“To be able to do this takes a focus and a great team of people,” Bingaman said. “This is what we do.”
Dr. Bingaman explained for the Rivard Report the numbers that drive kidney transplants in the U.S.
An estimated 26 million people nationwide are living with chronic kidney disease (CKD), a condition in which kidneys gradually lose functioning ability to filter wastes out of the blood. The final stage of CKD is kidney failure, or end-stage renal disease (ESRD), when 85% or more of kidney function is lost. When an individual reaches this point, he or she has two options: Go on dialysis or obtain a transplant.
The National Institute of Diabetes and Digestive and Kidney Diseases states that more than 661,000 Americans have kidney failure. Of these, 468,000 Americans are on dialysis – the highest rate of any country in the world.
As of Feb. 1, 2017, there are 98,381 patients on the waiting list to receive a kidney transplant, according to the United Network for Organ Sharing (UNOS).
Not Enough Kidneys to Meet the Need
While the number of kidney transplants increased in 2016 from a fairly constant level throughout the prior decade, the demand for kidneys continues to grow. The number of available kidneys simply cannot keep up with the demand. Of the 19,060 kidney transplants performed in the U.S. in 2016, 13,431 came from deceased donors and 5,629 from living donors.
“Texas Transplant Institute at Methodist Specialty and Transplant Hospital has done more live donor kidney transplants here than any other medical center in the U.S.,” Bingaman said. “The next biggest programs are at Northwestern and the Mayo Clinic, but here we have the largest.”
The results of the San Antonio-based program may come as a surprise, given the well-known kidney transplant programs at the Mayo Clinic, UCLA Medical Center, and Johns Hopkins Hospital.
The kidney transplant program at Methodist Specialty and Transplant Hospital provides patients a possible solution for their kidney disease.
South Texas residents are adversely affected by renal disease because diabetes, the leading cause of kidney disease, is so prevalent in the region. Hispanics comprise 39% of the state’s population, and their genetic predisposition to diabetes makes them about 1.5 times more likely to develop ESRD than non-Hispanics. There are estimated to be more than 55,000 Texans currently on dialysis.
“In Texas, there is a huge need for kidney transplants, with the average waiting period of six to eight years, which is longer than the waiting times in many other areas of the country,” Bingaman told the Rivard Report.
“Texas presents a unique challenge for several reasons: It has a broad and ethnically diverse population. And it comprises a very large geographic area with many rural areas that are underserved medically. This program is trying to increase access to kidney transplantation for every Texan suffering from ESRD.”
For those awaiting a kidney transplant but lacking a live-donor match, the only chance for a kidney donation may be from a kidney-paired donor (KPD) exchange. This offers a transplant option for patients with a living donor who is both willing and medically fit but isn’t a compatible match with the recipient.
The donor’s information is entered into a database with those of other incompatible donors and recipients who are willing to exchange kidneys. It is here that the process of finding suitable exchanges occurs. Kidney-paired donation provides a means for all transplant centers to increase patient access to live-donor transplantation.
Methodist Specialty and Transplant Hospital’s Program
Launched in 2008, the paired-donor program at Texas Transplant Institute at the Methodist Specialty and Transplant Hospital has performed more kidney-paired donation exchanges than any other center. The program focuses not just on the kidney recipient, but on the donor as well. All transplants are performed in one integrated facility, with targeted care provided for the donor from initial screening to post-surgery follow-up for two years.
The program’s approach to building community partnerships enables patient access and follow-up care in less populated areas across Texas. The program’s team has forged relationships with nephrologists throughout the state and through dedicated clinics in Corpus Christi, Laredo, McAllen, Lubbock, Waco, Temple, and Austin. The transplant physicians and team members visit these locations regularly to check on patients who have either donated or received a kidney.
“We build relationships of trust,” Bingaman said. “Community partnering in underserved areas is very important to patient outcomes. Our goal is to integrate our services with those of a patient’s nephrologist, so that we provide a true umbrella of care.”
Ending the Wait for a Kidney
Bingaman said education and awareness are the best ways to combat the rise in kidney failure.
“Education is a big part of what we do here,” Bingaman said. “A good support system is needed for both donors and recipients.
“We spend a lot of time on education to help patients make informed decisions. What are the benefits to the entire family unit? You are making their whole family’s quality of life better by improving the patient’s life and getting them off dialysis, which typically requires four-hour sessions three times a week – not counting travel time.”
Bingaman explained that this is why the outreach to more rural, underserved areas is so critical.
The Texas Transplant Institute at Methodist offers an educational seminar three to four times a year. The series (and videos here) teach people how to “End Your Wait” with an education program explaining living kidney donation and how to go about finding a donor on their own.
“We give them tools that help their awareness about the need for a kidney transplant,” Bingaman said. “We started this program because more than 50% of kidney donations do not come from family members. They are from coworkers, church members, or someone in the extended social network.”
“We’ve already hit a crisis point,” Bingaman said. “If you have kidney disease and diabetes and maybe heart disease, after six years on dialysis, you probably won’t be healthy enough for a transplant. So your best bet is to find a living donor as early as possible.”