
A kidney donor at 18 now regrets it - danso
https://www.washingtonpost.com/national/health-science/at-18-years-old-he-donated-a-kidney-now-he-regrets-it/2016/09/30/cc9407d8-5ff9-11e6-8e45-477372e89d78_story.html
======
danso
I admire the author's selflessness. At the same time, it seemed easier to be
selfless as a teenager, probably for similar reasons for why it's easier to
draft 18-year-olds than it is 28-year-olds. Given young persons willingness to
sacrifice for the greater cause without realizing that life extends well past
your 30s and 40s, I wonder if more shouldn't be done to let young donors think
of the risks, so that their naïveté isn't something that the system takes
advantage of.

The author's right to ask for better data and tracking of donors. That said,
his current worries are likely to be heavily informed by selection bias:

> _Five years after the surgery, when I was 23 and getting ready to go to
> medical school, I began working in a research lab that was looking at kidney
> donors who had gone on to develop kidney failure. For that research, I
> talked to more than 100 such donors. In some cases, the remaining kidneys
> failed; in others, the organ became injured or developed cancer. The more I
> learned, the more nervous I became about the logic of my decision at age 18
> to donate._

If you spend a lot of time talking only to donors where things have gone
wrong, yeah, you'll be paranoid. Reminds me of being a cops reporter in which
you strongly associate certain neighborhoods with shootings and murders
because, professionally, those incidents are the only times you ever visit
those neighborhoods.

~~~
criley2
>At the same time, it seemed easier to be selfless as a teenager, probably for
similar reasons for why it's easier to draft 18-year-olds than it is 28-year-
olds. Given young persons willingness to sacrifice for the greater cause
without realizing that life extends well past your 30s and 40s

I totally agree, the biological basis of this is Pre-frontal Cortex
development.

"The [prefrontal cortex] isn't fully developed and won't be until the person
is 25 years old or so."
[https://www.urmc.rochester.edu/encyclopedia/content.aspx?Con...](https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=1&ContentID=3051)

"This brain region has been implicated in planning complex cognitive behavior,
personality expression, decision making, and moderating social behaviour. The
basic activity of this brain region is considered to be orchestration of
thoughts and actions in accordance with internal goals."
[https://en.wikipedia.org/wiki/Prefrontal_cortex](https://en.wikipedia.org/wiki/Prefrontal_cortex)

I can't understand any other context for drafting 18 year olds other than
taking advantage of their youth and incomplete development, but avoiding
Presentism and the comfort of Mutually Assured Destruction / Pax Americana, I
can understand why when the cards are on the table and your entire society is
at risk, why you must call all hands, young and old, into Total War a la WW1
or WW2.

As far as donations go, that's got to be a morally gray area as well for all
the reasons you mention.

~~~
chrisseaton
> I can't understand any other context for drafting 18 year olds other than
> taking advantage of their youth and incomplete development

Physical fitness surely? Isn't 18 or 19 around the physical fitness peak? I'm
guessing that people are on average are significantly stronger and more robust
at 18 than they are at 28. I think the British Army has 26 as the limit for
joining in the first place for officers at least.

Also people are married by 28. At 18 they're generally single and more able to
deploy.

~~~
tajen
I'd say the peak strength must be 22-26, because 18-years-olds are really thin
and lean (source: I love men ;)) – unless they've been practising musculation,
but once again, if they practice musculation at 24, they'll be much bigger.
But it takes well above 2 years to train a professional, so profesional
recruitment takes them earlier. However, concerning draft followed by almost-
immediate use on the battlefield, given this subjective data, it makes little
sense to me, physically, to draft them so young.

~~~
doikor
It kinda depends on what kind of strength. For things where the athlete is
rather lightweight/small and does some kind of fast/twitchy power moves you
peak out somewhere before 30. But when all you need is pure strenght you have
30 to 40 year old world champions in many sports (you still have to start
training when a lot younger to make it though) for example in power lifting
where you have a lot of todays world champions born in the late 70s/early 80s.

One of the advantages (and disadvantages) of sending 18-20 year olds into
battlefield is that if they die society spent less money/effort into teaching
them some other valuable skill that would have been lost without getting the
benefit out of it (due to the person being dead)

------
smcnally
Kidneys are amazing -- filtering blood, removing excess liquid, regulating
blood pressure. And they're redundant! My brother lost one kidney in an
accident that also left him paralyzed and with a slew of other problems.
Recurring UTI and kidney infections took the other kidney a decade later. When
he started on dialysis around 1988, the machine was the size of an Asteroids
arcade game. It did half the job of a fist-sized kidney maybe half as well. A
few years later, we had a home machine a bit smaller than Asteroids. In 1994,
I gave him one of mine (kidneys, not arcade games).

The doctors said if the transplant lasted 10 years, we should be delighted,
especially with all his post-accident reconfigured internals. My brother's
quality-of-life improved immediately — at least he didn't have to be hooked up
to a machine and stationary for several hours at a time. My quality of life
was essentially unchanged. The transplant worked well for 22 years. Recurring
infections -- kidney, liver, bedsores, staph/mercer -- eventually took their
toll. I'm pretty sure I wouldn't have done it for "my stepfather's brother" or
the like, but I'm glad I did what I could for my brother when I did. I was 23
at the time and now 46. I drink plenty of liquids. My GP's a nephrologist and
I have kidney function tests as part of my annual bloodwork. Maybe I'll be
pissed if shit goes wrong as I age. With hope I'm still glad I did what I
could when I did. And, with hope, the redundancy remains very good.

------
JohnTHaller
There are real risks in the actual donation, of course. And some lifelong
things you need to worry about. It does affect treatment of other things. For
example, if you happen to have a rotator cuff injury, you can't just take high
doses of anti-inflammatory meds for a month. You have to do physical therapy
and steroid injections. And, in our wonderful US healthcare system, you'll get
near-zero aftercare beyond a few months worth of checkups. You'll have to
advocate for yourself for later extra checks on your remaining kidney's health
and often have to foot the bill yourself because your overpriced insurance
will refuse to pay for it.

Source: Am a kidney donor living in the US that has experienced both of the
above and several similar issues

~~~
leodeid
Can you explain the part about injury recovery? Are you not allowed to take
the medications because it would stress your kidney too much? (Also, do you
mean NSAID drugs, or are there issues with pretty much all anti
inflammatories?)

What are some of the things that you find yourself needing to advocate for
yourself about? Isn't long term care just annual creatinine level tests (which
looks like a simple blood draw)?

------
snake117
My physiology professor told our class to never donate, especially at our age
group (18-23). His presentation included some of the complications listed in
the article. However, his reasoning was straightforward: Assuming a long
lifespan, if you are in the position with your only kidney failing, you're
screwed.

He was speaking generally of course. Not every situation has an easy solution
and Poulson took a noble route, albeit when he was young and not fully
informed. I have heard med students suffering from slight paranoia because
they learn all kinds of diseases and their symptoms (as another comment has
stated). I wish all the best to Poulson.

~~~
labster
Assuming a long lifespan, if you are in the position with your only heart
failing, you're screwed.

~~~
pavel_lishin
So don't donate that, either.

------
avar
There's some down-thread armchair speculation about why humans have two
kidneys. I found it interesting, but instead of conniving my own theory did
some searching.

The gist of it is that nobody seems to know, but the most simple explanation
is that lateral symmetry is common in general because it's more efficiently
encoded in the DNA. The organs & structures that don't come in twos are the
odd exceptions, not the other way around.

1\. [https://www.quora.com/Why-is-it-that-humans-(and-many-
animal...](https://www.quora.com/Why-is-it-that-humans-\(and-many-
animals\)-have-two-kidneys-but-only-one-liver)

2\.
[https://www.reddit.com/r/askscience/comments/po4v6/why_did_w...](https://www.reddit.com/r/askscience/comments/po4v6/why_did_we_evolve_two_kidneys/)

~~~
AstralStorm
Most probably the kidneys are vital enough yet inexpensive enough to allow a
pair to exist. You do not get two hearts because that muscle is very
expensive. Also because a vascular injury to a major artery will also end your
life. Similar reason for the liver - too expensive and also easy to regenerate
from a partial injury. The brain is well protected and partly redundant. Lungs
are fully redundant and protected by the ribcage. Spleen is not critical
enough, stomach can heal. The pancreas is probably an odd one.

------
pdq
This is going to rub a lot of people the wrong way as unethical, but the best
way to incentivize organ donation is if the donors get paid a market price for
the organ. The donor is giving up a valuable piece of their body, taking time
and large medical risks in surgery, and likely reduced life expectancy.

If you walk through the current process, everyone in the donation gets paid --
doctors, nurses, hospital, pharma -- except the donor.

There are a number of advantages of donors getting paid:

1\. The supply market would increase dramatically. Thus many more people
receiving organs who would have otherwise died waiting.

2\. Heirs to people who have died young, with healthy organs could get paid
for donating their organs.

3\. Black markets would be dramatically reduced, since people in desperate
need of an organ could pay in the open, rather than secretly paying a donor.

4\. People without money can legally open a Kickstarter to raise funds for an
organ donation.

Note Iran has partially done this, and the results have been very positive
[1].

[1]
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1819484/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1819484/)

~~~
timecube
A big issue with allowing organ markets is that impoverished people can
practically be forced to sell their organs.

~~~
chrisseaton
Yes, often welfare systems won't give you aid if you have assets such as cash
or a home. Would your organs be considered assets?

~~~
bcherny
I'm not sure if it was ever verified, but reminds me of this story from 2005 -
[http://www.telegraph.co.uk/news/worldnews/europe/germany/148...](http://www.telegraph.co.uk/news/worldnews/europe/germany/1482371/If-
you-dont-take-a-job-as-a-prostitute-we-can-stop-your-benefits.html)

~~~
tremon
At the risk of sounding bitter: it's from a UK "newspaper" and it concerns
mainland Europe. You should assume the article needs additional proof, not
just verification.

------
dexterdog
This may be a dumb question, but why are previous kidney donors not given a
free pass to the top of the recipient list if they have a problem with their
remaining kidney?

~~~
gscott
..... or get your kidney back when the person you donated it to dies

~~~
dexterdog
Not a doctor, but I'm guessing that it's hard to re-transplant one and you
have to get the person to die the right way such that any donation is even
possible.

------
bcherny
Every med student I know went through a hypochondriasis phase. I wonder what
Poulson will think in a few years, once he is out of school.

~~~
delecti
That's really what this article seems to boil down to. There doesn't seem to
be any concrete data that should lead a completely objective donor to worry.
The issue is that the author is not completely objective (nobody is).

------
chetanahuja
I wish they had included another option in the survey. What if you were given
a lifetime of free health insurance in lieu of cash? This way, some
organization (the govt, AMA, some independent trust) could create a large,
insurable pool of all kidney donors. This scheme would work around the problem
of moral hazard in both directions. On the Donor side, donors get a
substantial financial reward but not in terms of cash. And if it's true that
most kidney donors will live healthy lives on par with the general population,
then this pool is no riskier to insure than any large company. In fact it
might be a _lower_ risk pool than the general population because the process
of selecting the donor candidate involves intensive medical checks. Basically
kidney donors are likely to be a healthier sample of the general population
than random selection.

On the recipient/govt side, you get better outcomes for a larger number of
kidney patients (and thus save lots of money on very expensive Dialysis
costs). Financially, recipients (or their insurance providers) can be charged
enough to cover the insurance premiums on the pool of donors without
encouraging a black-market of organ donations.

It's most likely a win for Insurance companies too since they have to foot a
large part of the dialysis bill too.

------
51Cards
Honest question. It sounds like the recipient was older so if something were
to happen to them (passing from old age, etc) would it be possible to move the
kidney back? After all it would be a perfect match... still the same age as
the donor, and as long as it hasn't been compromised in any way should still
function well.

~~~
smcnally
The organ has had x years in a foreign environment. The new host / donee has
taken an ongoing regimen of anti-rejection drugs for the duration to prevent
that foreign environment from being overly hostile. The organ is not
particularly suitable for re-transplantation even back to the original host.

------
ReallyAnonymous
As a surgeon who is 48, I will say that on my transplant rotation ( I am not a
transplant surgeon ) the theory of the safety of donation was in the Vietnam
War era data that said that soldiers who lost a kidney from injury were at no
increased risk of renal failure as the general public given similar risk
factors. I know that if you have hypertension or diabetes, it is near
impossible to donate a kidney as they have a high propensity to develop renal
failure. I have not researched the literature about the war data, but that is
what I was told.

~~~
laxatives
That isn't really a fair comparison. There's a selection bias among kidney
donors (they must pass some minimal health requirements) and are at a lower
risk than the general population.

------
kazinator
I suspect that this regret probably has quite a lot to do with the recipient
being the stepfather's brother. I.e. not a blood relative; kind of distant.

~~~
Viper007Bond
Says who? I know many people personally who are closer to their step-families
than they are to their blood families. Just because someone donated some of
their DNA to produce you doesn't necessarily make them worthy of being family.

Or hell, what about adopted children?

------
seesomesense
" All-cause mortality, cardiovascular mortality, and end-stage renal disease
(ESRD) was identified in 1901 individuals who donated a kidney during 1963
through 2007 with a median follow-up of 15.1 years. A control group of 32,621
potentially eligible kidney donors was selected, with a median follow-up of
24.9 years. Hazard ratio for all-cause death was significantly increased to
1.30 (95% confidence interval 1.11-1.52) for donors compared with controls.
There was a significant corresponding increase in cardiovascular death to 1.40
(1.03-1.91), while the risk of ESRD was greatly and significantly increased to
11.38 (4.37-29.6). The overall incidence of ESRD among donors was 302 cases
per million and might have been influenced by hereditary factors.
Immunological renal disease was the cause of ESRD in the donors. Thus, kidney
donors are at increased long-term risk for ESRD, cardiovascular, and all-cause
mortality compared with a control group of non-donors who would have been
eligible for donation."
[https://www.ncbi.nlm.nih.gov/pubmed/24284516](https://www.ncbi.nlm.nih.gov/pubmed/24284516)

------
Qantourisc
Hmmm in hindsight this is logical, you got 2 kidneys of a certain size.
Expected do 1 job together. And since biology doesn't like wastefulness (as it
cost energy, room, and nutrients to maintain) the kidneys are dimensioned to a
safe/good size. Now when you remove 1, the other one has to do twice the job.
Possibly severely dipping under the safe size.

In short, redundancy != excess

------
grimmdude
He's probably going to regret writing this article in ten years.

------
london888
Has the stepfather's brother with the new kidney not made the donor feel how
valuable his gesture was?

------
jimmywanger
Wait, he's complaining cause there's a higher theoretical risk, even though
he's experienced exactly zero consequences?

What is he writing about? "Sometimes something you do has potential future
consequences." Sounds like life.

------
pfarnsworth
Well, this article did a good job in scaring me off of donating any organs
whatsoever. I currently disallow donating organs upon my death, because I
think if I'm a known donor, the doctors might not try as hard to revive me.
And now after this, I'm pretty certain I won't take any tests to determine if
I'm compatible with anyone needing a kidney.

~~~
chimprich
> I currently disallow donating organs upon my death, because I think if I'm a
> known donor, the doctors might not try as hard to revive me.

Sorry, but that really is such a nonsensical argument I'm not sure if you're
serious. Why would a doctor not want to revive you? So another doctor
somewhere could save a patient? Why would that be preferable to saving your
life there and then? Why would the doctor risk their own career for that?

I presume that if you're refusing to donate any organs after your death, you'd
refuse one if you ever needed one (unless you're a huge hypocrite). In which
case, surely scenario A is far less likely than scenario B?

------
jlebrech
I guess he's going to be careful with his diet and not drink.

------
MrZongle2
TL,DR: author voluntarily donated a kidney to his stepfather's brother,
against the advice of much of his family. Years later, the recipient is doing
fine but the author (on his way to becoming a doctor), has reviewed the risks
of being a donor and now is nervous about the whole thing.

~~~
zodPod
This is an accurate summary. One thing I'd like to add is that there was
nothing that the receiver did that provoked the regret. I read this assuming
that something happened that caused it to not be worth it.

While this is a good view on this situation, the article is basically a guy
saying that his comfort and security to have a long life is more important
than the other guy's life. So I assumed that the other guy had done something
to bring this to light but that is not the case. The donator had simply
researched more and decided he was nervous.

To be clear: His interest in being secure in his life is fine and expected and
I'm not judging him by what I said.

~~~
MrZongle2
_"...the article is basically a guy saying that his comfort and security to
have a long life is more important than the other guy's life. So I assumed
that the other guy had done something to bring this to light but that is not
the case."_

This is how I went into the article as well. I expected seeing something about
the recipient being a substance abuser or otherwise not careful with his gift,
or some related drama. But it's really some light hypochondria and the
recklessness of youth on display.

I don't begrudge his regret; I don't know if I would have donated in the first
place if I had been in his shoes. I'm just not entirely convinced of the
overall worth of the article.

~~~
danso
I thought the article has overall worth because it's an honest reflection
about something we usually think of as a simple feel-good story. We pay
attention to selfless deeds when they happen, but usually don't follow up with
the aftermath. Apparently, according to the author, neither do hospitals,
which means there's a lack of data to do more longitudinal study.

------
rcthompson
To be fair, there's lots of other organs in your body that are _already_
single points of failure. Regardless, there's probably a reason we evolved
with two kidneys. My personal theory (i.e. I have no idea if there's any
actual research on this hypothesis) is that before humans discovered cooking,
agriculture, sanitation, etc., there were a lot more diseases and toxins and
such in the food we ate, so the organs responsible for handling them were much
more active than they are now. This is why you can get rid of your tonsils,
appendix, a large fraction of your liver, and one of your kidneys and still be
"fine".

(To reiterate, though, I don't know how much research there is to support this
theory.)

~~~
maxerickson
Keep in mind that fish also have 2 kidneys and 1 liver.

(humans have much else in common with fish:
[https://en.wikipedia.org/wiki/Chordate](https://en.wikipedia.org/wiki/Chordate)
)

------
treehau5
Reading these comments makes me believe the HN crowd no longer believes in
human exceptionalism, something I believe fueled our predecessors into
building mile long structures over bodies of water, landing on the moon,
striving to colonize mars, and other giant leaps of technology. Makes me sad
reading these comments.

