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When a Gift From the Heart Is a Kidney

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Aug. 9, 2000 -- For years they were dismissed as well-meaning but misguided souls or even cranks, but people who volunteer out of the blue to be living organ donors -- to give a kidney not to a relative or close friend but to a total stranger -- are now receiving serious consideration from organ transplant centers.

People who willingly sacrifice all or part of a vital organ for strangers are becoming increasingly common. In 1999, Jane Smith, a 42-year-old teacher from Fayetteville, N.C., gave one of her kidneys to a 15-year-old boy, a student in her homeroom class whom she had known for only two weeks. "I said, 'I have two, do you want one?" Smith told The Associated Press.

Also last year, Ken Schuler, a 46-year-oldman from Linville, Va., volunteered to give a part of his liver to a total stranger, a 39-year-old in need of a liver transplant, whose plight he had learned about on local TV. "I looked at my wife and said, 'I'd do that in a heartbeat,'" he told the Washington Post.

And although some people who think nothing of giving blood are troubled by the notion of parting forever with a vital organ, there are others of quite sound mind who see organ donation as a way of saving a life.

"We have occasionally been approached by persons offering to donate [one of their two] kidneys to any patient on the waiting list ... a process we call 'nondirected donation,'" writes Arthur J. Matas, MD, in the Aug. 10 issue of The New England Journal of Medicine. "Our policy has been to turn down these offers. But in view of the excellent outcome with the use of transplants from emotionally related donors [ie, spouses, close friends], the long wait for transplants ... and the persistent offers of donor volunteers, we decided to establish a policy for nondirected donation." Matas is a professor of surgery at the University of Minnesota.

The policy of Matas and his colleagues at the university calls for telephone screening of potential kidney donors, rigorous informed consent about the risks (both in written form and personal interviews), and detailed psychological evaluation to ensure that the donor is not mentally disturbed and is fully competent to make informed decisions about an irreversible medical procedure such as kidney donation.

Liver donation is even more complicated. Unlike kidneys, the liver can regenerate itself to full size in less than two months, making it possible to remove about half of a donor's liver for implantation in someone in need of a new liver. But the surgery for donating and transplanting a liver is more difficult, and puts both the donor and the recipient at greater risk for serious complications than does the same procedure for a kidney transplant. For that reason living-donor liver transplantation is rarely performed.

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